There are two bones in the forearm – radius and the ulna. When one or both the bones of the forearm have a fracture, we term it as Forearm Fracture. Both bones are important not only for proper motion of the elbow and wrist joints but also serve as important attachments to muscles of the upper extremity.
A most common reason for fractures is due to a fall on the hand, or a direct blow to the forearm (commonly seen in altercations, sports injuries, and car accidents). Pain, swelling, and deformity of the forearm indicate a forearm fracture. Proper diagnosis can be made with physical examination and x-ray studies.
Radial shaft fractures, ulnar shaft fractures, and fractures of both forearm bones are discussed below. Siora Surgicals has manufacture locking implants for hand fracture. Other Fractures that occur around the elbow (radial head fractures and olecranon fractures) and those that occur around the wrist (wrist fractures), will be covered separately.
Radial Shaft Fractures
It is not common to suffer an isolated fracture of the radial shaft. Most fractures of the radial shaft are associated with injury to the ulna (see ‘both bones forearm fracture’ below) or injury to one of the joints around the wrist (Galeazzi fracture).
An isolated radial shaft fracture, if it occurs, commonly requires surgery unless the fracture is non-displaced. If the fracture is out of position, then fracture is realigned to allow forearm rotation. Hence, surgery is the preferred treatment option to realign and hold the bones in the proper position.
Ulnar Shaft Fractures
An isolated fracture to the ulna is most often caused during an altercation and is called a “nightstick” fracture. Raising of the forearm in a protective posture exposes the ulna bone, which can be damaged by a blunt traumatic hit. The name is derived from the defensive gesture of people trying to shield themselves from a policeman’s nightstick leading to ulnar fractures.
If the fracture is well aligned, an isolated ulna fracture can be treated with immobilization in a cast. However, if the fracture is badly displaced, or the skin is broken causing an open fracture, then surgical treatment is advised.
Both Bones Forearm Fracture
Fracture of Both bones almost always require surgery in an adult patient. Without surgery, the forearm is generally unstable and to cast this type of fracture in a proper orientation is very difficult if possible. In younger children, nonsurgical treatment can be considered, but in adolescents, surgery may have to be carried out.
Fractures of both bones of the forearm are most commonly treated by fixing a metal plate and screws on both the radius and ulna bones. These bones have to be approached through a separate incision, necessitating, therefore, you will have two incisions on your forearm. Some surgeons may use a rod within the bone to maintain the position of the bone, but this cannot be done in fractures where rotational stability is required. Hence, both bones forearm fractures are mostly treated with plate and screws.
Complications of Forearm Fractures
The complications that are commonly encountered in such fractures include:
- Limited Motion: After the treatment of forearm fractures, decreased motion capability is common. It can be limited in the elbow and wrist joints but is most commonly noticed in forearm rotation (i.e. opening a jar or turning a door handle).
- Non-Healing Fracture: Due to inadequate healing of the bones of the forearm, there may be persistent pain. In open Fractures or where the bone is lost (i.e. many small pieces), this problem is more likely to occur. In such cases, repeat surgery for bone grafting may be necessary.
- Infection: Post-surgery, possibility of Infection is common. An infection in forearm fracture after surgery may require removal of the metal plate and screws to cure the infection.
Painful Hardware: Many times, the metal implants used during surgery can be felt under the skin and are painful. They can be removed, after the bone has properly united, usually at least a year after surgery.
The overview of the internal fixator has made MIPO a more practical theory and expanded its scope and range of applications.
The internal fixator is a submuscular or subcutaneously positioned external fixator. The design feature that is unique of the internal fixator is the locking head screw (LHS)- the screw head incorporates a double conical thread for safe fixation into a corresponding conical thread in the hole of the plate. This characteristic imparts a degree of angular stability to the construct because the locked screw head can no longer toggle within the plate hole. Also, because the screw head is secured within the plate hole, it doesn’t press the plate against the underlying bone as the screw is tightened, in contrast to standard screws such as cancellous or cortex bone screws.
The internal fixator, therefore, possesses characteristics that make it suitable for MIPO. These include:
- LHS which prevent the bone plate from being pressed against the underlying bone, therefore sparing the periosteal blood supply.
- Since the bone isn’t pulled against the plate by the LHS because the bone screws are tightened, there is no loss of primary reduction if the fracture has previously been reduced.
- Consequently, correct contouring of the plate isn’t necessary, a definite benefit in MIPO as the bone isn’t exposed for templating.
- Angular stability of the construct also avoids secondary loss of fracture’s reduction when placed under load.
- As the LHS are either self-tapping and self-drilling or only self-tapping, application of screw is made easier in the MIPO setting as drilling and/or tapping is no longer needed as is the situation with the application of standard screws.
The 1st internal fixator specifically intended for use in MIPO was the less invasive stabilization system (LISS) for the distal femur. As the benefits of the LISS became apparent, demand for a more versatile system risen, and this result in the development of the locking compression plate (LCP) with a specially intended combination hole, one half of which is intended as a dynamic compression until that enables the use of standard screws for interfragmentary or axial compression, while the other half is threaded to enable the application of LHS. Therefore, the LCP may function as a compression plate or as an internal fixator when only LHS are utilized.
In theory, no contouring of the LCP is essential when used as an internal fixator, however in practice, some degree of contouring is usually required, especially in the bone’s epi-metaphyseal segments. Otherwise, the plate can stand proud and become prominent subcutaneously or cause irritation of the adjacent soft tissue. To overcome this issue, specially intended metaphyseal plates were introduced. The special characteristics of this plate are that the juxta-articular end of the plate is thinned out to aid contouring and the two distal holes in this thinned part of the plate are angled at 11⁰ toward the center of the plate to enable optimal application of the LHS in the epiphyseal part in order to avoid penetration of the articular surface. A further refinement of this is the progress of anatomically preshaped LCP for use in specific epi-metaphyseal portions of the skeleton. The metaphyseal end of such a plate enables the insertion of a cluster of LHS in a convergent or divergent manner to improve their pull-strength. Additionally, no contouring of the plate is usually required. An added benefit of this anatomical preshaped LCP is that they may be used as an aid for indirect fracture reduction when utilized with standard screws. These may draw the bone toward the plate and therefore effect an adaptation of the bony fragments to the shape of the bone plate. Examples of anatomically preshaped LCP are the LCP distal humerus, locking proximal humerus plate (LPHP), LCP distal radius, LCP distal femur, LCP distal tibia, and LCP proximal lateral tibia.
Hands cannot perform its routine tasks without the use of the wrists. Hence, older individuals, who experience arthritis undergo various rehabilitative, non-invasive treatments to restore all or most wrist functions as soon as possible.
Unfortunately, cases of severe arthritis may cause patients to suffer from extreme pain and lose all functions of the wrist. It may also render the wrist unresponsive to non-surgical forms. This is where total wrist replacement comes in, also called wrist arthroplasty. Orthopedic instrument manufacturers provide orthopedic implants and medical devices to carry out the procedure of wrist arthroplasty.
Wrist Arthroplasty Surgery
The wrist is a complex network of bones, cartilage, and ligaments that each play a role in the smooth movement of the wrist. When the cartilage is worn away because of disease, injury, or infection, the bones of the wrist begin to rub against each other, causing unnatural wear on the ends. This is known as arthritis, which interferes with your ability to grasp objects.
Wrist arthroplasty involves removal of the damaged ends of the bones and replacing them with a synthetic joint, also called prosthesis. The prosthesis is made from medical-grade metal and high-quality plastic polythene and is intended to closely resemble the anatomy of the wrist.
The surgery can be performed under local anesthesia or general anesthesia, depending on one’s needs or preferences. An important point to note here is that modern wrist arthroplasty is performed on an outpatient basis.
Wrist Arthroplasty Rehabilitation
The first few weeks after surgery are spent wearing a cast that keeps the wrist in a neutral position to avoid swelling. Once the cast is removed, for the next 6 to 8 weeks, the patient must wear a protective splint. Total wrist arthroplasty rehabilitation spans anywhere from 3 to 6 months, restoring approximately 50% of healthy movement. The prosthesis lasts up to 15 years, depending on the physical demands of your everyday activities.
To prolong the life of prosthesis as well as resolve any complications at the point of time they occur, following up with orthopedic surgeon throughout recovery and every following year is the key to success. One also needs to work with a qualified physical therapist on pain management, and, eventually, exercises that restore endurance, strength, and range of motion.
Bone plates work like internal splints which hold together the fractured parts of a bone. These plates are available in all size, thicknesses, and shapes to suit the bone for which it is to be used. Over the years, developments in material science and engineering have led to the evolution of different shapes and size of the plates for clinical use.
In the initial phase of development of plates, surgeons such as Lane and Lambote used them to merely fix two bone fragments in approximate alignment. There were frequent Mechanical failures due to the metal reaction, inadequate design of screws and plates, etc.
The first use of interfragmentary compression by applying for plates under tension along the longitudinal axis of the bone was carried out by Danis, a Belgian surgeon in 1949. The concept was further explored and perfected thereafter by Muller and the AO group.
A bone plate has two mechanical functions. It transmits forces from one end of the bone to the other, bypassing the area of fractures and thus protecting them. Throughout the healing process, it also holds the fracture ends together while maintaining proper alignment of the fragment.
The names given to bone plates can refer to the shape of the plates (semi-tubular or one-third tubular plate), or some time to the width of the plate (broad or narrow plate). A name may be derived from the shape of the screw holes (round hole plate), or from the surface contact characteristics of the plate (low contact), or from the intended site of application (condylar plate).
Regardless of their geometry, configuration, length, thickness, or types of holes, all plates may be classified into four groups according to their function.
Neutralization Plate –
A neutralization plate transmits various forces from one end of the bone to the other, bypassing the area of the fracture and acts as a ‘bridge’. Its main function is to maintain a mechanical link between the healthy segments of bone above and below the fracture. Such a plate does not produce compression at the fracture site.
A plate used in combination with a lag screw is also a neutralization plate, counteracting the torsional, bending and shearing forces that tend to disrupt the screw. The lag screw contributes to the interfragmentary compression and stability. The neutralization plate merely protects the lag screw, allowing mobilization of the extremity.
In exceptional circumstances, a neutralization plate can produce compression at the fracture site, if the geometry of the fracture permits it.
The most common clinical application of the neutralization plate is to protect the screw fixation of a short oblique fracture of a long bone, or for the fixation of a segmental bone defect in combination with bone grafting.
Open reduction and internal fixation (ORIF) are one of the treatment options to fix a broken bone. It puts the parts of a broken bone together, so that they can heal. Open reduction means the bones are put back in their place during a surgery. Internal fixation means that special hardware is used to hold the bone parts together. This helps to correct the bone accurately. The procedure is done by an orthopedic surgeon using orthopedic implants & instruments provided by the orthopedic instrument manufacturers in India.
How do I prepare for a clavicle fracture open reduction and internal fixation?
Before ORIF physical and X ray examination of the site of injury is necessary. Doctor would like to get even details like the medicines you take, including over-the-counter medicines such as Aspirin. Also, tell your doctor the last time you ate.
Doctors might preform your ORIF as a planned process. If this is the case, ask whether you should stop taking any medicines ahead of time, for example, blood thinners. You will need to avoid drink and food after midnight the night before the procedure.
What happens at the time of a clavicle fracture open reduction and internal fixation?
An orthopedic surgeon and a team of specialized healthcare professionals will perform the procedure with the help of orthopedic surgery instruments obtained from orthopedic instrument distributors in Jakarta. The whole operation may take two hours. In general, you can expect the following:
- You will receive general anesthesia to make you sleep through the operation so that you would not feel any discomfort or pain.
- A healthcare professional will carefully monitor your vital signs, such as your blood pressure and heart rate during the operation. You may have a breathing tube placed down your throat during the operation to help you in breathing.
- After cleaning the affected area, your surgeon will make an incision through the muscle and skin near your clavicle.
- Your orthopedic surgeon will bring the pieces of your clavicle back into alignment (reduction).
- Next, your surgeon will secure the clavicle pieces to each other (fixation). To do this, she or he may use one or more of the Orthopedic Implants viz. bone screws, orthopedic plates, wires, and pins.
- Your doctor may make other essential repairs.
- Locking Reconstruction Plate 3.5 MM Staright is used for the clavicle fracture
- After the team has secured the bone, your surgeon will surgically close the layers of muscle and skin around your clavicle.
What happens after a clavicle fracture open reduction and internal fixation?
You may have some pain after your procedure, but pain medicine may help to lessen the pain. You should be able to resume a normal diet as soon as possible. You will probably require an imaging procedure, like an X-ray, to ensure that your surgery was successful. Depending on the extent of your injury and your other medical conditions, you may be able to go home that same day.
For a while after your surgery, you will need to keep your arm immobile. Usually, this means that you will need to wear your arm in a sling for several weeks. You will get instructions about how you can move your arm.
Your doctor might give you other instructions about caring for your clavicle, such as applying ice. Your doctor might not want you to take certain over-the-counter medicine for pain, because some of these can interfere with healing of bone. your doctor may advise you to eat a diet high in vitamin D and calcium as your bone heals.
You might have some fluid draining from your incision. This is normal. Let your doctor know right away if:
- You see an increase in swelling, redness, or draining from your incision.
- You have a high chills or fever
- You have severe pain
- You have loss of feeling somewhere in your body
Make sure to have all your follow-up appointments. You may need to have your staples or stitches removed a week or so.
At some point, you may need physical therapy to restore flexibility and strength to your muscles. Doing your exercises as prescribed can improve your chances of a complete recovery. Most people can return to all their regular activities within a few months.
A kneecap or a patella is a small bone that connects the thigh bones and your leg bones. The function of patella is to protect the knee joint, by acting as a shield. The bones of the patella, thigh, and legs are enclosed with articular cartilage, a slippery fluid that allows smooth bone movement when you walk. As the kneecap is a shield, it can get injured in tripping or falling. Knee fractures differ not only in the damaged area but also the level of damage. The kneecap could break into parts or slightly crack. It could happen at the center or top or lower areas of the patella. It could also exist in several portions of the kneecap. Some other variations could be displaced fracture, stable fracture, comminuted fracture, and open fracture. In stable fracture non-displaced fracture, the broken parts would be aligned, and they also remain in position at the time of the healing process. The broken parts aren’t aligned but are separated in a displaced fracture. Usually, this needs surgical correction.
An open fracture is a fracture when the damage isn’t only to the bone but also to the neighboring muscles, tendons, and ligaments, the skin may open to make the bone visible. This occurs during excessive damage and it is a complicated case. A comminuted fracture occurs when the bone gets shattered into more than 3 parts, it is known as a comminuted fracture.
The risk involved in knee fractures includes a direct impact on the knees. This happens when you fall during playing sports or walking or while motor vehicle accidents.
Usually, patellar fractures are caused by a direct blow to the kneecap, because of a vehicular accident or a fall. Sometimes, the kneecap can also get fractured by the violent contraction of thigh muscles.
The symptoms of a fracture in the knee include:
- Excessive knee pain
- Swelling in the knee
- Inability to straighten the knee
- Inability to walk
- Bruises in the injured part
To prevent knee fractures, you must take the following points into consideration:
- Be extra careful if you are old and have other bone disorders like osteoporosis
- Careful when you play or walk on slippery surfaces
- Exercise mildly to improve your body balance and strength
If knee fracture gets severe, it may require surgery. The surgery is performed by skilled orthopedic surgeons. The surgeons sue various orthopedic products in the surgery that are provided by the orthopedic product manufacturer. The locking plate system of Siora comprises of implants and instruments that are used in the knee surgeries.
In an External Fixation System, pins are inserted in the skin into the bone and held in place by an external frame. Thus, there is no placement of Orthopedic implants internally.
The usual indications are open fractures such as a tibia fracture which needs dressings or attention to a wound or flap. It can also be used with closed fractures, for example, unstable radius fracture.
External fixation is most successful in superficial bones, for example, tibial shaft. Avoid it in deeper bones, e.g. the humerus or femur – here the chance of pin tract sepsis is greater.
Indications for External Fixators:
External Fixators are often used in the management of tibial fractures.
Indications for External Fixators
- Bad soft tissue damage/ Severe open fractures
- Infected fractures
- For “Damage Control Orthopedics” (where the patient’s initial condition is too critical for prolonged surgery) to maintain length and provide stability. The exfix is replaced by definitive fixation (IM pin or pate) once the patient stabilizes. A temporary exfix can be placed over the joint for plateau or pilon fractures that are length unstable. It is later removed when ORIF is performed, once soft tissue swelling subsides.
Advantages of External Fixation
- The method provides rigid fixation of the bones in cases in which other forms of immobilization, for one reason or another, are inaccurate. This is most common in open, severe II and III fractures in which traction or cast methods wouldn’t permit access for Management of the soft tissue wounds and in which dissection and exposure to orthopedic implant an internal fixation appliance would devitalize and contaminate larger areas and might significantly increase the risk of infection or loss of the limb itself.
- Neutralization, compression, or fixed distraction of the fracture fragment is possible with external fixation, as dictated by the fracture configuration. Uncomminuted transverse fractures can be optimally compressed, length can be maintained in comminuted fractures by pins in the major distal and proximal fragments (neutralization mode), or fixed distraction can be obtained in fractures with bone less in one of paired bones, such as the ulna or radius, or in leg-lengthening procedures.
- The method allows direct surveillance of the limb and wound status, including wound healing, viability of skin flaps, neurovascular status, and tense muscle compartments.
- Associated treatment, for example, skin grafting, dressing changes, bone grafting, and irrigation, is possible without disturbing the fracture alignment or fixation. Rigid external fixation allows simultaneous and aggressive treatment of bone and soft tissues.
- Immediate movement of the distal and proximal joints is allowed. This aids in reduction of edema and nutrition of articular surfaces and retards capsular fibrosis, muscle atrophy, joint stiffening, and osteoporosis.
- The extremity is elevated without pressure on the posterior soft tissues. The orthopedic pins and frames can be suspended by ropes from overhead frames on the bed, relieving pressure on the posterior soft tissue part and aiding edema resolution.
- Early patient mobilization is allowed. With rigid fixation, the limb can be moved and positioned without fear of loss of fracture place. In uncomminuted, stable fractures early ambulation is often possible; this may not be the case if these fractures are treated by casting or traction. Use of external fixation also enables the mobilization of some patients with pelvic fractures.
- Insertion can be performed with the patient under local anesthesia if required. If the general medical condition of a patient is such that use of a spinal or general anesthetic is contraindicated, the fixator can be inserted using local anesthesia, although this is not optimal.
- Rigid fixation can be used in infected, non-unions or acute fractures. Rigid fixation of the bone fragments in infected fractures or in infected established nonunions is a critical factor in obliterating and controlling the infection. This is infrequently possible with traction or casting methods, and implantation of internal fixation devices is usually ill-advised. Modern external fixators in such instances can provide rigidity not afforded by other methods.
- Rigid fixation of infected, failed arthroplasties in which joint reconstruction is not possible and in which arthrodesis is desired can be achieved.
A thumb sprain is a severe condition that can occur in athletes, physically active people or simply anyone who experiences an injury relating to their hand. Many would consider this as a minor injury that will gradually heal on its own when, in fact, a thumb sprain can affect your ability to grasp, therefore impairing the functionality of the affected hand. So, it is necessary to consult a doctor, who will examine and treat you in time using orthopedic instruments, procured from reputed orthopedic instrument Manufacturer.
The main ligament that controls the function of your thumb is called the ulnar collateral ligament, spanning between the index finger and thumb. During a fall, instinctively one extends his arm to catch oneself, therefore causing the hand to bear most of the impact. This is the most common reason for thumb sprains, as the impact from a fall can cause an extensive tearing or stretching of the ulnar collateral ligament.
Skiers are usually most susceptible to severe thumb sprains, a condition also known as “skier’s thumb”. When a fall occurs in the process of skiing, the ski pole creates extra stress on the thumb ligament and increases the chances of a tear. Contact, ball sports, racket are other activities where the thumb is at risk of a sprain because of trauma such as a sudden hit or a fall.
Thumb sprains are among the toughest conditions to self-diagnose, as the onset of pain may not be immediate. Other symptoms may include swelling, tenderness, or bruising. If you experience any type of thumb injury, it is important to visit an orthopedic specialist whether you notice any symptoms or not, as leaving a sprain untreated may lead to complications in the thumb function.
When the ligament is partially torn your thumb will need to be immobilized with a splint or cast for approximately 4-6 weeks until the thumb regains its full stability. When the ligament is fully torn and/or there is any sign of bone fracture, you will need surgery followed by a recovery period of 6-8 weeks. The surgery is performed by the orthopedic surgeons using various instruments accessible from top orthopedic implant companies in india.
A bone plate may be placed so that it may be utilized for one of the following kinds of structural support:
- Compression Mode
- Neutralization Mode
- Buttress plate
- Antiglide plate
- Bridge plating or span plating
- Tension band
Plates are available in various shapes and sizes depending on the bone size and its anatomical shape. Similarly, Bone Screw size is dependent on the size & type of plate used. A small plate will typically be used for a small bone, which allows space only for the screw of smaller size.
Depending upon the fracture type and location, a plate can be used in any one of the following methods
The word compression in fixation of a fracture means bringing the two fragments closer to one another so that the fragments oppose well.
When the plate is utilized to achieve compression with the fracture fixation, it is said to be utilized in compression mode. This mode is utilized on oblique and transverse fractures.
In this kind of plating, a lag screw is utilized to neutralize shear, bending and rotational forces. The goal of this kind of plating is not to attain compression (this has already been attained by the lag screw).
This type of plating is also utilized as an adjunct where bone screws are used alone in long bones an accurate reconstruction with interfragmentary compression can be attained, but screws are not strong in resisting twisting or bending forces. Addition of a bone plate offers further resistance to such forces.
The fibular fracture normally seen in ankle injuries is usually fixed with lag screws protected by a neutralization plate.
The orthopedic plate is put on the tensile surface of the bone, but it is not pre-bent.
A buttress is an architectural structure built against or projecting from a wall which helps to reinforce or support the wall.
A buttress plate is utilized to prevent collapse in fracture patterns which are unstable under compressive forces.
A buttress plate is very thin in comparison to compression plate and is usually applied on the compressive surface of the bone.
This is the most commonly used plates around joints.
Here there is a comparatively soft cancellous bone core enclosed by a thin layer of cortical bone. Correct osteosynthesis may be attained by lag screws alone but under load, there may be a risk of screws cutting out of the bone or bending.
The addition of a bone plate will prevent such deformity under axial load. The plate should be located where the maximum load is predicted to be. Proximal tibia, for example, plates may be needed on one side or another to protect a fixation of tibial plateau fracture.
For the most common anatomical buttressing needs, there are specially shaped plates.
In antiglide plating, the plate is fixed to the bone in such a manner that it prevents the distal fragment from overriding when force is applied along the long bone axis.
The distal fragment is firmly impacted between the plate and the fracture surface of the proximal plane.
This principle is generally applied in distal fibula fracture. It can be termed as a variation of compression plating.
The wrist contains two forearm bones: the ulna and the radius. The most commonly encountered fracture in the wrist is that of the distal radius, the end of the larger of the two arm bones at the thumb-side of the wrist. Generally, Distal radius fractures occur about one inch from the end of the radius and are caused due to injury when one falls on an outstretched hand or if one has osteoporosis or low bone density. The injury causes swelling, pain, and bruising and can create a deformed appearance to the wrist.
The length of time for recovery differ greatly between patients. It is essential to have your recovery guided by your physician and a certified hand therapist. It is necessary to keep the wrist elevated and to keep the fingers moving by making a tight fist as often as possible. There is no reason to use a squeeze ball. An empty fist is the best. It is very common to have swelling and stiffness in the fingers and hand for quite some time after a wrist fracture.
Stable fractures that do not affect the joint alignment are treated without surgery. Initial treatment generally includes elevating the arm, icing, and anti-inflammatory medications to control swelling and pain. A splint may be used for 1 to 3 weeks to allow for swelling. After the swelling is subsided, the splint will be replaced by a fiberglass cast. After the injury, the wrist is typically immobilized for as many as 6 weeks. A sling may be worn for comfort, but it is important to work on maintaining a full range of movement of the elbow and shoulder to prevent stiffness. Regaining range of motion of the forearm and wrist is the focus for the first few months, followed by strengthening. In most cases, return to sports may be expected no before 3 months from the start of treatment. After the cast is taken off, a removable splint can be worn either for strenuous or full-time activities until the fracture is fully healed.
For more serious fractures, surgery may be needed to correct the alignment of the bone. Sometimes a cast alone can be used, or it may be essential to insert metal pins, bone screws and an orthopedic plate.
Another common fracture is of the scaphoid bone which is a small bone in the thumb-side of the wrist. It is a common sports injury and is often a result of a fall toward an outstretched arm.
Treatment depends on the location of the break. Fractures at the end of the bone, close to the thumb, often heal in a few weeks when placed in a cast. If the scaphoid is broken in the middle of the bone or closer to the forearm, healing can be more difficult and need a long-arm cast or surgery.
When the scaphoid is broken at the proximal pole or waist, surgery may also be recommended. The surgery requires orthopedic implants that can be accessed from the top orthopedic implant manufacturers in India. Wires and bone screws are used to stabilize the bone, so it can heal properly. After surgery, the wrist may be put into a cast, however, even with surgery, these fractures can be hard to heal.