Ask a doctor - What is the treatment of old scaphoid bone facture with avn?

Q. What is the treatment of old scaphoid bone facture with avn?

Doctor Answer is medically reviewed by SecondMedic medical review team.

Answered by Secondmedic Expert

The treatment of an old scaphoid bone fracture with avascular necrosis (AVN) depends on the degree of bone loss, the presence or absence of symptoms, and the patient's overall health. In cases of mild AVN, where there is no pain or limited mobility, a conservative approach with exercise and activity modification may be adequate. However, if there is significant pain or decreased mobility then surgical intervention may be necessary.

Surgery for scaphoid fractures typically involves arthroscopy to establish an accurate diagnosis and understand the extent of damage caused by AVN. Then debridement can be performed to remove any remaining non-viable tissue before stabilizing any remaining viable tissue in place using pins. The pins are then secured in place via a plate or screws which provide stability until healing occurs.

Another surgical option that can help preserve range-of-motion while also aiding healing is called proximal row carpectomy (PRC). This procedure involves removing one row of bones from the wrist joint so as to create extra space for movement without placing additional strain on nearby tendons or ligaments that could further damage them due to increased pressure and friction during movement. As a result, PRC offers improved range-of-motion compared to regular pinning techniques as well as improved long term outcomes due to less risk of tendon/ligament damage resulting in further injury down the line.

Finally, reconstruction surgery is sometimes used when all other options have been explored but still no satisfactory outcome has been achieved due atrophic nonunion (i.e., when bone cannot heal naturally). During reconstructive surgery additional bone grafts are placed into areas where they are needed most; either externally taken from another part of your body such as your knee cap/shinbone area tapings)or internally taking advantage stored fossilized bones available at cadavers banks among others sources prior treated by gamma sterilization for safety purposes). These grafts will provide much needed support for rebuilding strength/stability in order to reestablish alignment within damaged joints allowing full recovery from old scaphold fractures with AVN..