bone filled in with scar tissue

[gordon999]

2 years ago I experienced a compound break of the wrist, dislocated arm bone, crushed scaphoid and extensive ligament damage. Shortly after i underwent surgery to reconstruct the scaphoid and the ligaments on the dorsal end of my hand. To this date im satisfied as much as can be with the ligaments, i have 100% supination of the wrist and about 70% of reflexion and forward movement. The scaphoid has a herbert screw burried within it. The scaphoid itself is not all bone, im pretty sure both ends of it are together however thers a chunk missing from the middle that is supposedly filled in with some kind of fibrious scar tissue.

Now, my problem is this, im in my early twenties, I do rather intensive exercise(boxing, weightlifting) and i get the occasional hurt if i punch bad or something which i dont like. I would like to know if it would be a smart idea to go through with a possible bone graft procedure to remove the scar tissue and replace it with bone. The screw thats in there now would come out, and a new one would have to be inserted to hold the bone graft in place.

I dont know how well this scar tissue in the bone will hold its strength, i dont want to run into bone collapse problems when im 50 and have a procedure and have it not work at all because im too old or something.

What do you think, is this scar tissue worth leaving in its place and continue on beating the hell out of my wrist and hope it solidifes into something like bone or do the procedure and risk even more problems then they were intended to fix...whats your standing on this scar tissue business?

Ultimately my problem is that i want to eliminate the pain i experience in the bone when i throw a normal punch.

[Zaynah]

hi there

i'm a physio from south africa.
another member had a scaphoid fracture and a piece of the bone died... they did a bone graft with a new fixation pin. It would be a good idea to mail or post on his topic and ask about the procedure and what he endured and it still struggling with post operative. He still has pain when he does straining exercises with his wrist pushed backwards like in a push up. The pain comes from the scaphoid bone not being anatomically or physiologically 'normal', its got an abnormal shape, size, bone density and tensile strength. When you punch a bag or put strain on or weight through your wrist, the scaphoid bone takes up alot of the forces/weight. The scaphoid bone articulates (in contact with) with many other small bones in the wrist and they fit like pieces of a puzzle. So if's its not functioning normal, or slightly disrupted in any way, you will have symptoms.

If you are trying to 'harden' the bone by doing these impaction exercises, you are actually doing more harm. Your body will not form proper bone, it will form connective tissue, and not only in the bone, but in the surrounding ligaments as well. The problem with the scaphoid is that it doesnt have a good blood supply to begin with, so when fractured, pieces may die and break off, or the entire scaphoid can become like a jelly bean... weak and fragile. Thats why there's so many non-union cases out there.

Bone grafts do work well in cases like these because the surgeon places normal bone with good blood supply (vascularized) into the injured-fragile bones' place, it thus strengthens the bone and helps the healing process start up again. After complex scaphoid fractures, many people complain of residual symptoms because the scaphoid is in such a complex position with many joints, ligaments and arteries, it seldom functions (biomechanically) correctly.

Below is the link to a very good informational website on non-union of the scaphoid and bone graft surgery:
http://www.maitrise-orthop.com/corpusmaitri/orthopaedic/105_mathoulin/mathoulinus.shtml

The best thing will be to find a good hand reconstructive orthopaedic surgeon in your region and discuss all your concerns with him. If he seems arrogant and not interested in hearing YOUR concerns, get a second opinion... some specialized surgeons will perform surgeries without giving a damn about the patients concerns or long term problems.... trust me i know. Good luck

[gordon999]

Thank you for your input. It is much appreciated and in the future I will certainly discuss this with various specialists. Thank you for your time.

[gordon999]

Im sorry to bother you again, but i must have as many opinions as possible. This is that when i consulted my fracture specialist who performed the procedure on me (ligament reconstruction, dislocated radius bone {the arm bone connected to the scaphoid}, and a completely crushed scaphoid with a herbert screw burried completely within the newly formed scaphoid),,,x-rays show there seems to be a union of the bone, but a small section of the bone itself healed back as some kind of fibrous scar tissue.

(the event happened 2.5 years ago and ever since the doctor has been satisfied with teh results enough to say theres nothing i cannot do)

Now, another thing the doctor noticed was that the screw was no longer threaded into the bone,, so the way i understand is its basically in the bone but not doing anything...however once agian he said this but without raising any concern.

My problem is this., i still feel pain not usually AT THE TIME of vigourous exercise (beating punching bag) but sometimes a couple days later it feels sensitive. IVe been doing this kind of exercise for almost a year now and it just seems to be getting better (in terms of ability to avoid direct pain) ,

Im pretty sure its not the resconstructed ligaments/scar tissue that does the hurting im pretty sure its the incompletey-bone screw-implanted scaphoid bone

My question for you is this, i MUST be able to continue on heavy weight lifting and punching full force, it seems to be only getting better at this point, What im worried about is this, the screw is basically no longer holding the boner together because its not threaded into bone anymore,,, IF i continue this sort of vigourous exercise into my thirtys and forties will this screw keep moving around throughout time and grind away at the bone as i put it through the required motions of exercises such as dips and flat-handed pushups and cause more problems or is it wise to risk the bone graft procedure to scrape away that connective tissue part and insert a new scrwe after removing the old BURRIED one...

Im trying to get as many opinions as possible this is a serious dilemma in my life and i feel i must address it sooner than later because im still young. thank you for your time.

(my appologies for the repetitiveness)

[Zaynah]

hi

if the screw that was inserted to stabilize the fracture initially, is loose, it can be a problem. the instruments used in these surgeries usually gets removed, as they are only beneficial while the bone heals. If the dr removes the pin, he must make sure that the integrity of the boen (strenght) is good enough, other wise he will have to make use of grafts to stabilize it or place in another screw. I don't think it could be a problem getting the screw removed as it is loose, and you have had union of the fracture.

The discomfort you have a few days after impact activities with your wrist is from inflammation... the ligaments, capsules and tendons get injured with micro-tears everytime you strain them like you do, and then the body reacts by releasing chemicals in the joints and near the micro-injured structures, to heal the body itself. So, to minimize the inflammatory phase after strainful activities, apply ice to your hand. Do so for the next 2 days and see how it goes. If you can find a sore sport on the hand near the joints or bones when you press on it, it can help you identify which structures are being strained.

Good luck.

[focus_911]

Hi there,
Everything Zaynah has typed out is good advice. I will also add, tho I am not sure where you live, weather has a huge affect on your joint when hardware is in place. I had a wrist arthroscopy a week ago today. Part of the procedure was to remove a screw which was out in to fuse together some of the carpals bones due to some severe ligamentous injuries.During the procedure they actually broke the screwdriver when trying to take the screw out...so the hardware is still in place.

A good way to relieve some day to day aching is to get it removed. Can make a big difference.

Cheers.