# Scaphoid and Titanium screw



## Surfinguru (Feb 6, 2004)

Hey, anyone have the Herbert screw surgery done to fix their scaphoid? I'm going in for surgery on the 19th and am wodering what to look out for.


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## AMessy (Jun 30, 2004)

*Get it*

Just my opinion, i'd get the surgery. I broke my scaphoid 3 years ago, and had it in a cast for 10 months. I'm sure you know but due to the small amount of blood flow to that bone it takes forever to heal. I was supposed to get the surgery after like 4 months but they told me the xrays showed it was starting to heal...yet it still took another 6 months after that.

Bottom line, unless you wanna be casted up for close to a year, or if the break is close to the side of the bone were the blood flow is and might heal fast, i'd get the surgery.


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## Surfinguru (Feb 6, 2004)

10 months?!? Man, that's a long time. I've been casted for the last 3 months. I showed some signs of healing in the x-rays at 2 months, but this months x-rays looked just like the ones at month 2. I had actually asked for the surgery after 8 weeks, but because there was SOME healing, the doctor sugested giving it a little more time.

Hey, so after that long of a time with your wrist immoblized, how long did it take you to regain range of motion? That must have been almost as bad as being in the cast itself.


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## Master_Jako (Mar 27, 2004)

i got a smashed wrist right now and its nothing big, 5 weeks left in the cast....just wonder what a scaphoid is....


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## AMessy (Jun 30, 2004)

Yeah when i got it off was the worst, I kept getting a new cast every 3 or 4 weeks through out it, but it was pretty nasty. I had to go through about 2 1/2 months of therapy to get back to about 90% mobility. When i got it off i had almost 0% mobility for about a week. It quickly came back though with the therapy. Hopefully you're lucky and it will heal quick.

The wost part about it was when i went to the hospital it was a friday and the only clinic i could get into was the Univeristy clinic, and the docter their didn't know how to cast for that break so i had to sit with a cast from my fingers up to my shoulder for a weekend until i could get into the hand specialist at the regular hospital. After that i just had a cast from my fingers to about half way up my forearm.


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## waukeetx (Oct 1, 2004)

*iscaphoid break sucks*

Hey,

I'm in a cast right now!!! I broke my scaphoid in August dirt jumping, I didn't even realize it was broken until about two weeks after the fact. I spend two weeks moving furniture carrying things it was ridiculous!! I moved all my stuff out of an entire house and into another. Now it's been just over three weeks in a cast and it's by far the most uncomfortable cast yet. I fear the worst has yet to come.'

Is anyone else feeling crappy because they can no longer ride?? Has anyone else noticed just how hard it is to fill the time once dedicated to biking?? Whatever, health is more important then biking...right..??...not that I have a choice.

From the sounds of everyones experience, the healing process is very slow if one is even lucky enough to have it heal. I"m hoping that I won't need surgery, and by reading everyones response am quickly realizing that there is no way i'll have the cast off two weeks from now.

Has anyone ever had the waterproof fiberglass cast? Is it worth the extra 40 bucks? I'm Canadian so normally the cast is free.
Also, did any of you get an M.I.R.'s before considering surgery?

Good luck - stefan


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## AMessy (Jun 30, 2004)

I also had the bone broken for about a month before i realized my sore hand was problem messed up. They told me that waiting to get it casted didn't make it worse, just that it didn't start to heal until i finally got the cast on and stopped moving it. 

I didn't have an M.I.R., only x-rays. They could tell from the x-rays that it was lined up and starting to heal, so the docter decided i should let it heal naturally. 

For the waterproof cast, i don't know what to tell you, i had the regular cast for like the first 2 times, and the next 8 or 9 were the waterproof ones. The only crappy thing about the waterproof ones are that once they get wet underneth, they take likea day to dry out in there, but i would like ram towels in there to sorta dry it. Wrapping the cast up in a bag all the time to shower was a pain so for that aspect the waterproof ones are nice.

Just so i don't sound too negative, when i had my hand broke, my neighbor told ne he broke his scaphoid and it only took him like 4 months to heal. So there is hope


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## Surfinguru (Feb 6, 2004)

Yeah, from what I could find on the net, it's like an 80/20 rule. 80% heal quickly and 20% don't. I didn't know mine was broken either. Since I had fractured the radius in my left arm at the same time, the focus was there. (Those fractures were healed in 7 weeks.) Originally, I just thought I had just sprained my thumb on the right hand. Diagnosed the scaphoid break two weeks later when I went to see the Orthopedic surgeon. 

I had the regular fiberglass type casting. I suppose you could get it wet, but as AMessy said, it takes FOREVER to dry out. Then, it just makes your arm reek even more. I just bagged the arm every day to shower. Pain in the ass for sure, but worth avoiding the soggy arm sindrome.

AMessy, thanks for the heads up on the rehab stuff too. Sounds like if I'm lucky, I might be able to ride some time in January. Right now I can't touch my ring finger with my thumb and I can only bend the wrist forwad and backward about 10 degrees. I'll just keep working on it until the surgery in the hopes of reducing the rehab time.

Oh and MasterJako, this is what a scaphoid is:


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## Gramatica (Jun 25, 2004)

Ever tryed consulting this Doctor.










lol...im sorry....I had to.


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## gratefulbiker (Mar 15, 2004)

No scaphoid break but, I learned alot about the wrist when I broke my lower arm. I had two breaks at the distal end of the radius and a crack of the styloid process of the ulna. Titanium plate with six screws, five weeks in a cast, four weeks in a removable splint, and three weeks of therapy. My scaphoid is still the limiting factor in my recovery, even though there was no specific damage to it. Three months after the surgery, my range of motion is still limited mainly because that one little bone won't glide under the other bones the way it is supposed to. All I can say is to keep moving those fingers while you are in the cast and once you can start therapy, give it everything you can. It will really suck the first week or so, but it's the only thing that will get you back on the bike quicker. Good luck.


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## DH Diva (May 25, 2004)

I broke both hands and shattered my wrist 9 weeks ago. My schaphoid was broken in half, and the lower portion was shattered. I had the herbert screw/bone graft and replacement surgery a week after the accident because my wrist/hand had to be reconstructed, as the hand was sheered off the wrist and not really attatched. I also sheered the head off the radius, severed all the ligaments and soft tissue on the underside of the wrist and had a bone graft, 9 screws and two plates to put it all back together. 

The herbert screw surgery is a pretty straight foward surgery, but with a lengthy recovery time depending on how quickly if ever the bone regenerates and starts pushing blood again. The herbert screw with bone graft surgery is more complex, and requires a longer healing time, as bone grafts are very sensitive and require a long time to heal. 

The main problem, is if the scaphoid doesn't heal, it's not like a regular bone. It will actually go necroptic and die and have to be removed. If this happens, you have to have a procedure called a four point fusion of the hand, where they fuse several bones in your hand into one piece, so your thumb and hand are supported properly. Because of this, doctors usually extend healing times, so they are 100% that the bone is good to go, before letting a patient use it again. Having a few extra months in a cast and a stiff wrist, is much better than having a fused hand. 

As for casting, see if your hospital or surgeon do thermo plastic casting. It's not a fiberglass cast, and not a waterproof cast. It's a custom fit cast made from heat activated moldable plastic. It has adjustable straps to adjust as swelling moves and changes, is fully removable so you can keep it and your arm clean, and it allows access for scar tissue massage, thus reducing the stiffness from prolonged immobilization. I'm really happy with mine so far, which is good because I'll probably be in it through the end of the year. 

My biggest piece of advice is to let it heal. Give it lots of time, because it will need it, and you'll be better off in the end because of it. It's a serious injury for being such a small bone so you have to treat it like a serious injury, and not forget how much it can screw your life up later if you don't let it heal. Sorry to through out all this unpleasant stuff, but I'm still fighting an uphill battle to be able to use my hand again, and am going through all of this stuff right now! I just want to pass on to others things that I'm learning along the way, in hopes that it helps someone out. If you have any questions just PM or e-mail me. I'm more than willing to talk about stuff and give advice/ answer questions. Good luck and let that thing heal!


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## Brian Peterson (Feb 20, 2004)

Surfinguru said:


> Hey, anyone have the Herbert screw surgery done to fix their scaphoid? I'm going in for surgery on the 19th and am wodering what to look out for.


I let mine heal on it's own, and was out for 4 months.... A friend of mine did the surgury and was riding in a month. Out of all the people I know who fractured the scaphoid, mine was the only one to heal naturally. The surgury is pretty straight forward from what I understand... But you will still be sore for a while...

Brian


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## Master_Jako (Mar 27, 2004)

wow...i hope i never break my scaphoid ever..lol..and i thought a smashed radius and another chiped bone in my wrist was bad, i lucked out...good luck people with your wrists/hands... im just glad ill be riding in 6 weeks.


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## munga (Jan 20, 2004)

*Surgery*

yeah, i'd get the surgery. I'd never even considered surgery for a broken bone until i smashed my tibia and fibia clean in half about 15miles down some singletrack. Once they finally got me to hospital (carried on a stretcher) they said i could have a cast (12 weeks cast + another 12 on crutches) or surgery (6 weeks on crutches, no cast) the choice was simple. Lots of rehab latter and i'm just getting into jumping again, i did it in March. If i had a cast, i doubles the healing time.

The main downside of surgury: I've got all these bolts in my leg, they're anoying and have to come out in 6 months. This means another month of the bike, and another visit to the hospital.

So from my experience, and from reading what others have said about the scaphoid, get the surgury, and take time healing.

Best wishes and good luck


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## soboko (Aug 18, 2004)

i broke this when i was 14. only thing is i didn't know it, and the bone healed slightly wrong. it really hurts to do push ups or anything where i have to bend my wrist back and put a lot of weight on it. also noticed problems in a yoga class i tried out. to fix it, they need to go in and break the bone again, reset it, and then go through the normal healing process. for what i do it's not worth it...


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## wyrm (Jan 19, 2004)

I broke my scaphloid one year ago. I ran around using it still thinking I only had a sprain up till November and had my surgery in December after I found out. But since I used it so much the brokne ends were rubbed together so much that they had to add a bone graph in there. I have a screw in there to hold it all together. 

The recovery time for me was quick. I had the cast for only six weeks. Was on the bike two months after the surgery. I think for the best results you need to eat really healthy and take vitimans. Follow all the doc rules very strictly. Get plenty of rest. I've read once in med journal that carbonation in drinks attacks the bones in your body, so I avoided that for a long time, I still don't drink much of it.


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## tingj (May 20, 2004)

Surfinguru, ask your doctor about an Acutrak screw. Herbert screws are archaic. They require very invasive surgery to put in. Both ends of the bone have to be freed and placed in a guide jig. Accutrak screws are cannulated (hollow) and are implanted using a guide wire without an incision. Recovery time is shorter. Acutrak screws have largely supplanted Herbert screws for the fixation of non-displaced scaphoid fractures.

If your doctor doesn't know what an Acutrak screw is, I would find another -- and make sure they are a fellowship-trained hand surgeon. PM me and I can recommend one in your area.

JT


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## DH Diva (May 25, 2004)

tingj said:


> Surfinguru, ask your doctor about an Acutrak screw. Herbert screws are archaic. They require very invasive surgery to put in. Both ends of the bone have to be freed and placed in a guide jig. Accutrak screws are cannulated (hollow) and are implanted using a guide wire without an incision. Recovery time is shorter. Acutrak screws have largely supplanted Herbert screws for the fixation of non-displaced scaphoid fractures.
> 
> If your doctor doesn't know what an Acutrak screw is, I would find another -- and make sure they are a fellowship-trained hand surgeon. PM me and I can recommend one in your area.
> 
> JT


Just a note, as I'm working with one of the best hand surgeons in the PNW, Acutrak screws are not necessarily always better than a herbert screw. In some situations, like mine for example, the herber screw is more effective because it is stronger and easier to re-align the bone fragments. The guide wire insertion also only works well when the scaphoid is only cracked or clean broken in one spot. In a scaphoid fracture where it is either shattered or broken in several pieces, it is actually more difficult to get a Acutrak screw in place properly. It's not a matter of one method being archaic, just a matter of what is more appropriate given the injury.


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## BikeSATORI (Mar 20, 2004)

Hey, I toasted my scafoid snowboarding a couple years ago- looked like I had a baseball implanted in my wrist after it happened! Had to drive myself to ER. They tried to reset it but couldn't, then had the surgery right away (a week or so later), was only in a cast for about 3 weeks afer I think because the doc wanted me to move it so my wrist wouldn't fuse up. It took me awhile to get full movement- couldnt' do a handstand for around 8 months, even push ups were hard w/ hand flat.
I don't know which screw I got, but still have a decent little scar, and it pops a lot, really loud every morning. Now its no prob, but let me tell you - This is not even close to ACL knee reconstructive surgery- NEVER EVER tear you acl if you can help it!!! 
Good luck man, work off that atrophy after the cast comes off!


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## tingj (May 20, 2004)

DH Diva said:


> Just a note, as I'm working with one of the best hand surgeons in the PNW, Acutrak screws are not necessarily always better than a herbert screw. In some situations, like mine for example, the herber screw is more effective because it is stronger and easier to re-align the bone fragments. The guide wire insertion also only works well when the scaphoid is only cracked or clean broken in one spot. In a scaphoid fracture where it is either shattered or broken in several pieces, it is actually more difficult to get a Acutrak screw in place properly. It's not a matter of one method being archaic, just a matter of what is more appropriate given the injury.


Well, whether or not you think Herbert screws are archaic depends on how old you are and how set in you ways you are. Indeed, some still use them who are very skilled. But their numbers are dwindling. However, for a nondisplaced scaphoid fracture, which it sounds like the OP has, it would be difficult to support using a Herbert screw over an Acutrak. BTW, a herbert screw is not stronger than an Acutrak. And an Acutrak can be used even in the setting of communution. I use it even in nonunions with an corticocancellous interpositional bone graft. But this is an argument for another board. I only suggested the OP know all the options before proceeding.


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## DH Diva (May 25, 2004)

tingj said:


> Well, whether or not you think Herbert screws are archaic depends on how old you are and how set in you ways you are. Indeed, some still use them who are very skilled. But their numbers are dwindling. However, for a nondisplaced scaphoid fracture, which it sounds like the OP has, it would be difficult to support using a Herbert screw over an Acutrak. BTW, a herbert screw is not stronger than an Acutrak. And an Acutrak can be used even in the setting of communution. I use it even in nonunions with an corticocancellous interpositional bone graft. But this is an argument for another board. I only suggested the OP know all the options before proceeding.


And, any GOOD doctor would know that you can't diagnose the best method of surgery over the internet. My main point, regardless of which method would work best for Surfinguru, is that one is not always the right or best choice. There are situations that benifit from both methods.


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