Complications can arise from both conservative and surgical treatments of scaphoid fractures. These may include delayed union, osteonecrosis, pseudoarthrosis leading to instability, arthrosis, and carpal joint collapse. These complications can significantly limit wrist function, impacting mobility and grip strength. In surgical cases, additional risks include malalignment, screw misplacement, the need for re-operation, infections, and soft tissue injuries. Prompt and accurate diagnosis and appropriate treatment strategies are crucial in emergency medicine to mitigate these risks and manage scaphoid fracture complications effectively.
Delayed union in scaphoid fractures can be addressed using bone stimulators or magnetic field therapy to encourage bone healing [41]. While medicinal treatments have been suggested, their efficacy lacks strong evidence, and they are not widely accepted [42]. In the emergency medicine setting, recognizing delayed union early is important to initiate these treatments and prevent further complications.
Pseudoarthrosis, or non-union, often presents without symptoms initially but can become painful and evident after new trauma or excessive wrist strain. The occurrence of pseudoarthrosis following surgery varies with fracture type, ranging from 5% to 50% [43,44]. Symptomatic pseudoarthrosis typically requires surgical intervention. Anatomical fracture reduction and proper intra-articular alignment during the initial emergency management phase are vital to prevent early arthrosis. Surgical treatments for pseudoarthrosis involve debridement, realignment, and bone grafting (vascularized or non-vascularized), often with osteosynthesis [45,46,28]. Success rates for these procedures range from 74% to 94%, although outcomes are less favorable in proximal pseudoarthrosis [47]. Currently, there is a lack of prospective randomized clinical trials comparing vascularized and non-vascularized bone grafting techniques for scaphoid pseudoarthrosis.
Arthrosis is a late-stage complication of scaphoid fractures. In cases of established arthrosis, achieving substantial pain reduction and functional improvement becomes challenging. “Rescue” operations for arthrosis include styloidectomy, carpal joint denervation, and scaphoid excision with four-quadrant fusion (fusion of the lunate, triquetral, capitate, and hamate bones). Early diagnosis and effective initial treatment in the emergency setting are paramount to minimize the risk of developing such severe late complications.
The existing evidence base for both diagnosing and treating scaphoid fractures, particularly in the context of emergency medicine and complication management, is limited. Scaphoid non-union remains a significant clinical challenge. Early recognition of scaphoid fractures and advancements in their acute treatment are essential to reduce the incidence of non-union and avoid long-term complications. Emergency medicine plays a critical role in the initial diagnosis and management that can significantly impact the long-term outcomes of scaphoid fractures and prevent the need for complex treatment of complications.
