Name of the Procedure:

Closed Treatment of Carpal Scaphoid (Navicular) Fracture without Manipulation

Summary

In this procedure, a fracture of the carpal scaphoid bone (also known as the navicular bone) in the wrist is treated without surgically manipulating the bone. This typically involves immobilizing the wrist with a cast or splint to allow the bone to heal naturally.

Purpose

This procedure addresses fractures of the scaphoid bone in the wrist, which often occur due to falls or direct impacts. The goal is to allow the bone to heal correctly and prevent complications such as non-union or avascular necrosis (death of bone tissue due to lack of blood supply).

Indications

• Pain and tenderness in the wrist, especially in the area near the base of the thumb.
• Swelling and bruising around the wrist.
• X-ray or other imaging confirms a scaphoid fracture.
• The patient does not require surgical intervention based on the fracture type and alignment.

Preparation

• The patient may be advised to avoid eating or drinking if sedation is planned, although this is rare.
• Removal of any jewelry or clothing that could interfere with applying a cast or splint.
• An X-ray or other imaging tests to confirm the type and extent of the fracture.

Procedure Description

1. Imaging: A healthcare provider confirms the scaphoid fracture via X-ray.
2. Immobilization: The wrist is immobilized with a cast, splint, or wrist brace. This could involve a thumb spica cast that covers the forearm, wrist, and thumb.
3. Monitoring: Regular follow-up appointments to monitor the healing process through physical examination and repeated imaging.

Duration

The casting part of the procedure takes about 15-30 minutes. However, the healing process may take 6-12 weeks, during which the patient will need to wear the cast or splint.

Setting

The procedure is typically performed in an outpatient clinic, emergency room, or doctor's office.

Personnel

• Orthopedic specialist or general physician
• Nurse or medical assistant

Risks and Complications

• Skin irritation or pressure sores from the cast.
• Non-union (failure of the bone to heal).
• Avascular necrosis (death of bone tissue).
• Stiffness or reduced movement post-recovery.

Benefits

• Non-surgical approach with minimal intervention.
• Allows the bone to heal correctly, restoring function and reducing pain.
• Reduced risk of complications compared to surgery.

Recovery

• Follow instructions for keeping the cast dry and clean.
• Avoid heavy lifting or strenuous activities with the affected wrist.
• Follow-up visits to monitor healing progress.
• Physical therapy may be recommended once the cast is removed.

Alternatives

• Open reduction and internal fixation (surgery): For severe or displaced fractures.
  • Pros: Directly aligns bones and may offer faster healing.
  • Cons: Higher risk of infection, anesthesia risks, and longer recovery.
• Percutaneous screw fixation:
  • Pros: Minimally invasive, faster recovery.
  • Cons: Requires surgical intervention.

Patient Experience

During the casting process, the patient might feel some discomfort but generally not pain. After the procedure, they may experience mild pain and discomfort, which can be managed with over-the-counter pain medications. The patient will need to adjust to limited wrist movement and follow post-care instructions meticulously to ensure proper healing.