Scaphoid Fixation
in Rockhampton

What is going on

The scaphoid is a small boat-shaped bone at the base of the thumb, the most commonly fractured of the wrist's eight carpal bones. The injury typically follows a fall onto an outstretched hand and presents as tenderness in the anatomical snuffbox — the small hollow at the base of the thumb. The scaphoid has a tenuous retrograde blood supply that enters near its waist and travels backward toward the proximal pole, which means fractures of the upper end are at risk of avascular necrosis (death of the bone fragment) and nonunion (failure to heal). Standard wrist X-rays miss a substantial proportion of acute scaphoid fractures, and the diagnosis is often confirmed only with CT or delayed-imaging follow-up.

Not sure if this is the right diagnosis? The wrist pain hub and thumb pain hub triage the differential by anatomical location.

What the operation involves

Percutaneous scaphoid fixation is performed through a small incision at the base of the thumb under fluoroscopic guidance. A guide wire is passed along the long axis of the scaphoid, the fracture compressed, and a headless cannulated compression screw (Herbert or Acutrak design) is inserted over the wire to hold the fragments tightly together. The operation usually takes 30 to 60 minutes under regional and general anaesthesia; patients leave hospital the same day. Where wrist arthroscopy is added, the procedure also identifies and treats associated ligament or chondral injuries, which are present in a substantial proportion of acute scaphoid fractures. Full clinical detail is on the education page.

For full clinical detail — incision, anaesthetic, post-operative instructions and the printable patient handout — see the scaphoid fixation education page or the wrist surgery overview.

How this case is handled

In-person review at two weeks for wound check, six weeks with X-ray to confirm screw position and early union, then three months with imaging to confirm radiographic union before clearance for full activity. Coordinated hand therapy with Ruby Doolan in the same suite is integrated into the post-operative pathway. Patients from outside Rockhampton can usually transition to therapy closer to home after the early intensive sessions.

Fees, Medicare rebates and the surgery-quote process are on the fees page. The case for seeing a fellowship-trained surgeon — and what fellowship training adds — is set out separately. GPs can find the referral pathway, urgency triage and what to include in the letter on the referrer page.

What this operation is billed under

The procedure is covered by the following Medicare Benefits Schedule items. Surgeon, anaesthetist, assistant, hospital and prosthesis fees are quoted separately and in writing before surgery — see the fees page for the practice's quote process and an explanation of why surgical fees follow the Australian Medical Association schedule. Surgery does not proceed without itemised written informed financial consent.

Item 47357 Treatment of fracture of carpal scaphoid, by reduction with fixation

Single item covering scaphoid fixation by any means (percutaneous compression screw, open compression screw)

Patient questions we hear most

• I fell on my hand a week ago and the X-ray was normal — could I still have a scaphoid fracture?

  Yes. A substantial proportion of acute scaphoid fractures are not visible on the initial set of plain X-rays — the fracture line is fine and the bone is small. Persistent tenderness in the anatomical snuffbox at two weeks after a fall is treated as a scaphoid fracture until proven otherwise, with CT or MRI used to confirm the diagnosis. Missed scaphoid fractures are one of the most common reasons for a wrist that does not settle after an apparent sprain, and the consequences of missing one are significant — nonunion, avascular necrosis and eventually wrist arthritis.

• Why do I need surgery if the bone might heal in a cast?

  For stable, nondisplaced waist fractures a cast is a legitimate option. The trade-off is twelve weeks of continuous immobilisation with the risks of stiffness, muscle wasting and inconvenience, balanced against a roughly 5 to 15 per cent rate of nonunion that may still need surgery later. Percutaneous fixation halves the time to union, allows earlier movement and reliably restores anatomy. The threshold for offering surgery is lower for patients in physical work, for proximal-pole fractures, and for displaced patterns where cast treatment has a substantially higher nonunion rate.

• How much does scaphoid fixation cost? What does Medicare cover?

  Scaphoid fixation involves separate fees for the surgeon, anaesthetist, hospital and the surgical implant. The practice quotes the surgical fee in writing before booking — the Medicare item, the rebate and the out-of-pocket gap each shown separately. Dr Hirpara's surgical fees follow the Australian Medical Association schedule, which is higher than the Medicare scheduled fee; the fees page explains why. Surgery does not proceed without itemised written informed financial consent.

• When can I go back to playing sport?

  Light non-contact sport (running, cycling on a trainer) is usually reasonable from six weeks, contact sport once radiographic union is confirmed at around three to four months. Premature return to contact sport before union risks displacement of the fragments around the screw and ongoing pain. Wrist guards or splints are sometimes used during return-to-sport for an additional period of protection.

• Will the screw need to be removed?

  The headless compression screw is buried entirely within the bone and is designed to stay in place for life. Screw removal is rarely needed and is only considered if the screw becomes prominent or symptomatic. The screws are MRI-compatible and do not set off airport security.

More general questions about appointments, fees and the practice on the FAQ page.