Diagnostics and treatment of acute scaphoid fractures

Abstract

Fractures of the scaphoid bone are common but can easily be overlooked in standard X‑rays. Inadequate diagnostics and therefore inappropriate treatment of scaphoid fractures often leads to problems in healing with formation of non-union and painful osteoarthritis of the wrist. This review summarizes the current practical recommendations in the diagnostics and treatment of acute scaphoid fractures. An analysis and review of selected literature including the current S3 guidelines were performed. The main statements are that in cases of aclinically suspected scaphoid fracture, staged diagnostics including radiographs, computed tomography (CT) and when necessary magnetic resonance imaging (MRI) should be applied to confirm or exclude afracture. Further treatment in the case of afracture is planned according to aCT-based classification. There are fracture types that can be treated either conservatively or operatively and there are other fracture types that always require operative fixation. The operative technique depends on the exact fracture geometry. For osteosynthesis, cannulated headless compression screws are mostly used.