Arthroscope assisted minimally invasive management of scaphoid fractures with missed diagnosis and delayed treatment

Abstract

Objective To assess the effectiveness of arthroscopically assisted minimally invasive management for neglected scaphoid fractures in the subacute stage. Methods Between January 2012 and January 2015, ten patients who had a neglected scaphoid fracture were treated with arthroscopically assisted percutaneous fixation with or without arthroscopic debridement and bone grafting. Preoperatively fracture displacement, fracture sclerosis and bone absorption were evaluated on radiographic images. Fracture displacement and stability were further assessed intraoperatively via direct arthroscopic visualization through the mid-carpal portal. Based on the displacement and stability of the fracture, and the extent of sclerosis and bone defect, arthroscopic guided direct percutaneous internal fixation; arthroscopic debridement, reduction and percutaneous internal fixation; or arthroscopic debridement, bone grafting and internal fixation were carried out. Results The average postoperative follow-up time was 14.7 months (range, 6 to 36 months). Bone union was achieved in all ten patients at a mean of 11.3 weeks (range, 8 to 17 weeks). According to the Mayo wrist scores, overall functional outcomes were rated as excellent in 9 cases and good in 1 case. Conclusion Arthroscope assisted minimally invasive management is a reliable and favorable approach in the treatment of scaphoid fractures with delayed diagnosis and treatment. It affords direct visualization of the fracture site which enables tailored management. Key words: Scaphoid bone; Fractures, bone; Wrist arthroscopes; Minimally invasive surgery