Scaphoid

Scaphoid means boat-shaped, but the human scaphoid bone is more like a kidney bean shape than most boats !

The human scaphoid bone of the carpus (wrist) has a precarious and notorious retrograde arterial blood supply and hence it is vulnerable to a number of unique complications.

The scaphoid bone is often fractured during fall onto the outstretched hand (the classic FOOSH injury). Often these patients do not realise they’ve fractured as the pain can be minimal despite the fracture being present. So, they might present late for their first x-ray.

Secondly, the initial x-ray can be very misleading. A hairline crack through the “waist” (middle) of the bone is sometimes near impossible to identify even in an an experienced set of eyes. A CT scan or Technetium 99 bone scan might help diagnosis in some cases.

Once the fracture is identified it may not heal prophet due to the weak blood supply mentioned above. Delayed union and even non-union are well described and not uncommon.

Furthermore, the bone may suffer from insufficient arterial flow, and become necrotic – termed avascular necrosis (AVN) – or dead bone- most commonly at the “proximal pole” or the elbow-end of the scaphoid bone. We typically identify AVN by its bright white radio dense appearance on plain Xray. It is also characterised by abnormal MRI signal.

If untreated a scaphoid non-union may progress to even more sinister complications which include cavity formation at the fracture site (cavitary non union) and SNAC wrist (scaphoid non union advanced collapse) a form of pan-scaphoid widespread wrist osteoarthritis.

Dr Kirkham is widely regarded as an expert on scaphoid fractures and non-unions. DR Kirkham has published the largest series in ethe world on the treatment of the worst group – the cavitary non-union group, using a technique that is cheap, simple, reliable and has the highest ever published union rate e in the world at over 97-98% success rate. Dr Kirkham continues to lecture and research on this topic every year.

Dr Kirkham has presented this research at state, national and international peer reviewed conferences. He has been invited to speak on this topic at national and international meetings.