HOW SCAPHOID FRACTURES ARE TREATED IN BRAZIL.

Gustavo Chaves Nacif,Vinicius Ynoe De Moraes,Marcela Fernandes,João Carlos Bellot,Fernando Moises Jose Pedro

doi:10.1590/1413-785220182605184659

Abstract

ABSTRACTObjectiveTo verify how hand surgeons manage scaphoid fractures and their complications.MethodsTwo hundred questionnaires were distributed during the 36th Brazilian Hand Surgery Congress (2016).ResultsOn suspicion of fracture without radiographic confirmation, 57% of surgeons request a CT or MRI scan, while 43% opt for immobilization and consecutive radiographs. In stable fractures the preference was for treatment with plaster cast. In fractures with no scaphoid waist displacement, 33% opt for percutaneous fixation. In displaced waist or proximal pole fractures, 66% and 99.4%, respectively, opted for surgical treatment. Most surgeons treat waist nonunion with a nonvascularized bone graft. When absorption at the site of nonunion is greater than 4 mm, 50% prefer to use iliac graft and screw fixation. In proximal pole nonunion, the Zaidemberg technique is preferred by 64%. More experienced surgeons are more likely to request tests in occult fractures (63.9% versus 47.6%; p=0.04), and tend to recommend surgery for distal third fractures more frequently (16.4% versus 4.7%; p=0.02).ConclusionsWe have provided an overview of treatment preferences for scaphoid fractures. It should be noted that more experienced surgeons are more likely to request additional tests for occult fractures and to recommend surgical treatment of distal third fractures. Level of Evidence IV, Cross-sectional survey.

Highlights

The scaphoid is the most commonly fractured carpal bone
We have provided an overview of treatment preferences for scaphoid fractures
In the treatment of scaphoid waist pseudarthrosis, with focal absorption of up to 3 mm, most used bone grafts (68%), while percutaneous fixation with compressive screws was performed by 32% of the interviewees

Summary

Introduction

The scaphoid is the most commonly fractured carpal bone. In adults, 70% of scaphoid fractures affect the waist; 20%, the proximal pole; and 10%, the distal pole. Fractures occur mainly in young adults, an economically active population, after low-energy trauma or in association with sports practice.[1] Given that the scaphoid is the main carpal bone, its integrity is vital for stability and mobility of the wrist. Increased risk of non-union is associated with fractures of the proximal pole, fractures with an associated carpal ligament injury, delay in diagnosis, inadequate immobilization,[2] and smoking. Radiographic examination is indicated in the initial evaluation; 16% to 27% cases show a false-negative result. More specific examinations such as magnetic resonance imaging (MRI) must be performed in order to shorten the time for diagnosis, decreasing the direct and indirect costs of treatment.

Methods

Results

Discussion

Conclusion