I fell off a ladder and broke the scaphoid bone in my right wrist. I’m extremely right-handed, so this is causing quite a problem for me. I’ve had the wrist in a cast for quite a while, but it doesn’t seem to be healing. They are talking about doing surgery next. Do you think the fact that I’m not moving it is why it isn’t healing?

Immobilizing a broken bone in a cast is needed to keep the bone fragments from moving around while the body tries to heal itself. But when union of the bone fragments doesn’t happen, then it’s time to look at what’s causing this delay in bone healing.

It could be a problem called avascular necrosis. Avascular means without blood and necrosis refers to the death of bone. Sometimes the blood supply to the bone gets cut off as a result of the injury. Without an adequate source of blood, healing won’t occur.

Surgery to restore blood flow and hold the bone together until it does heal may be the next step in treatment. But first, the surgeon must identify what’s causing this delay. Patients with diabetes, heart disease, or peripheral vascular disease have a known delayed time in wound healing.

Anyone who uses tobacco products of any kind is also at increased risk for failure to heal or delayed healing. In the case of a bone fracture, the result can be a nonunion of the bone. Some surgeons not only advise their patients to quit smoking before surgery, they insist on it. They know that’s what it will take to ensure a successful result. A urine nicotine test is done before surgery to confirm smoking (or tobacco-use) cessation.

Your surgeon will help you identify any risk factors that might be preventing healing. Immobilizing the wrist isn’t likely the problem.