For the morbidly curious, here is some information on scaphoid fracture.
Including where the scaphoid is. The "AAOS" is the American Academy of
Orthopaedic Surgeons.
http://orthoinfo.aaos.org/topic.cfm?topic=A00012
A questions was posted earlier to the list regarding scaphoid fractures
which I responded to personally. The person posting the question asked me
to post my response to the list, which is below. Scaphoid fractures are
common in cyclists and other people that fall on their outstretched hand.
Scaphoid (navicular) fractures are bad actors. They tend to heal slowly and
are prone to non-union (not healing). Worse yet they will often develop
avascular necrosis (death of the bone due to loss of blood supply). All of
this is because the blood supply is low, most of it coming from a recurrent
branch of the radial artery. To add to this bad news, scaphoid fractures
often go unrecognized because many of them are not very painful so people
with them often don't seek treatment immediately. In addition, many
scaphoid fractures are difficult to see on plain x-ray so they may not show
up until after there is some healing (at least 10 days after the fracture)
or may need CT or MRI to be seen.
In general I tend to be one of those sort of guys that ignores conventional
instructions and starts using and moving things early. I would not suggest
that with this fracture. Early and aggressive immobilization of the wrist
and thumb is essential. I think that the immobilization also needs to
control pronation and supination of the forearm (turning the hand from palm
down to palm up). This means that the cast or splint needs to go over the
elbow. Failure to control pronation and supination may allow the fracture
fragments to rotate relative to each other and interfere with healing. Time
off the bike should be long, at least 8 - 12 weeks or until there is good
healing on X-ray and clinically. This is because pressure across the wrist
from putting your hands on the bars will tend to move the fracture fragments
and impair blood flow. In addition, you don't want to take the risk of
falling on your outstretched hand yet again until the healing is well along
and the bone is back to close to normal strength. This conservative
approach will hopefully decrease the risk of nonunion and avascular
necrosis.
Traditionally these fractures have been treated with immobilization alone.
Unfortunately because of the prolonged immobilization patients often end up
with stiffness in the wrist. There are several different surgical techniques
for treating these. Although surgery may not get you back on the bike
quicker it can get you out of a cast quicker. Whether surgical or
non-surgical treatment is used and the timing of that surgery (early after
the fracture or later if there are lack of signs of healing or development
of complications) depends on the location and severity of your fracture, as
well as other items specific to you. Personally I would suggest that you
see a hand specialist with this fracture and thoroughly discuss options with
him.
Mike Murray
Depending upon how bad the break is will determine how long you will be off
of the bike. The biggest problem is the downward weight bearing; putting
pressure directly to the scaphoid/nevicular area. 3 months is usually the
time frame for such a boo-boo. If you need pins and wire, the down time is
a bit longer because of the invasive nature of the surgery.
Brod
Has anyone dealt with a scaphoid wrist fracture before? How long did you
wait to ride your bicycle on the road after the break? How long before you
were able to race again? Any residual pain or things you wish you would have
done differently in treatment?
Cara
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