Scaphoid Fracture Postoperative Rehabilitation

The scaphoid is the most common carpal fracture. Most of scaphoid fractures heal up well by themselves given time and prompt treatment. Surgical intervention is indicated if there are any signs that the fracture is not healing through simple immobilization. Generally, for fractures with displacement, associated with wrist dislocations and fractures of the proximal third of the scaphoid bone regardless of displacement, the surgery is indicated (1). Fractures with even small amounts of displacement are prone to nonunion, and operative treatment is recommended. Bone grafts are indicated for non-unions. Depending on the location of the fracture and whether the injury is acute or chronic, the surgical …show more content…
RICE to control edema and infection. The surgeon places the patient in a long-arm or short-arm thumb Spica cast (First 10 days). The therapist fabricates a fore-arm-based thumb Spica splint, leaving the IP joint free, for protection after cast removal. Patients are commonly immobilized until scaphoid union is observed, which can sometimes take up to four months.
2. AROM and PROM of digits, except the thumb, consisting of blocking and controlling limitations. During exercises patient may remove the splint.
3. Soft tissue mobilization and metacarpal gliding to restore palmar mobility and function of the distal transverse arch.
4. AROM exercises to elbow and shoulder joints.
Goals: Protection with cast/splint, control pain and edema, maintain ROM in uninvolved joints, and gaining functional activities of daily living.
Sub acute phase: 4-7 Weeks
1. AROM fingers (2-5), elbow and shoulder
2. If fracture healed appropriately at 6 weeks, cast or splints removed continue with carefully AROM exercises for wrist and thumb.
3. Mobilization of the wrist and scar massage will applied to protect stiffness and scar formulation.
Goals: Control pain and edema, protection with splint, increase ROM, and functional …show more content…
• Monitor for signs of compartment syndrome, which is typically a medical emergency. The most useful, early clinical sign for the presence of a compartment syndrome are inordinate pain, which is usually worsened by passive stretch of the musculature within the compartment. Traditionally, one notes the “5 Ps”: pallor, parasthesias, pulse deficit, paralysis, and pain on passive extension. Immediate attention is necessary to avoid the disastrous effects of muscle necrosis.
• Nonunion of scaphoid fracture is 20% more common in smokers. Smoking, taking steroids (cortisone), birth control pills, or other hormones (insulin) may postpone the healing (3).
Throughout the rehabilitation the therapist should monitor the patient for signs of nonunion, such as pain with pinching or with wrist loading. Radiography should repeat in 6 to 12 months to ensure union. Range of motion (ROM) is severely affected when a joint has been immobilized for a long period of time and atrophy of muscles in the forearm and hand will also occur. For this reason, rehabilitation can take several months. A successful outcome is union, functional wrist motion, and pain-free grip