Acute Scaphoid Research Articles

Demographic Characteristics and Factors Associated with Acute Scaphoid Fractures: An Analysis of 903 Patients

Objectives A comprehensive understanding of the epidemiology of scaphoid fractures is crucial to aid in diagnosing and treating patients with suspected injuries. The study aims to assess demographic characteristics and factors associated with acute scaphoid fractures in adults. Methods A retrospective review identified all patients with acute scaphoid fractures over four years at a single institution. Data collected included baseline demographics (age, biological sex, race, and ethnicity), body mass index, tobacco and alcohol use, pertinent medical history, and treatment modality. Laterality, location, and displacement of the fracture were confirmed on radiographic analysis. Results A total of 903 scaphoid fractures were included. The majority of fractures occurred in males (n=570, 63%) and were in the left hand (54%), unilateral (99%), nondisplaced (71%), and treated definitively with nonoperative management (71%). Nearly two-thirds (66%) of fractures occurred along the scaphoid waist, followed by the distal third of the scaphoid (25%). Proximal third fractures accounted for the smallest proportion of scaphoid fractures (8.6%) but had the highest displacement and surgical intervention rates compared to waist and distal third fractures. Younger age, male sex, fractures of the proximal third, and displaced fractures had higher odds of being treated surgically. Conclusion The scaphoid is one of the most frequently fractured carpal bones. Young adult males may be at an increased risk for injury. Patients with displaced fractures and those involving the proximal third require surgical intervention at higher rates.

Diagnosis and Management of Acute Scaphoid Fractures: A Narrative Review of Current Literature

Abstract Introduction: The scaphoid is the most common carpal bone to fracture in adults as well as children. The symptoms of acute scaphoid fractures, however, could be subtle and might be disregarded by patients initially. Conventional radiographs have limited reliability in ruling out these fractures, with 15%–25% of nondisplaced fractures remaining undetected. The resultant delay in diagnosis, along with the inherent tenuous vascularity and high mobility of the scaphoid, results in the high probability of complications such as nonunion, malunion, avascular necrosis, pseudoarthrosis, or scaphoid nonunion advanced collapse. The purpose of this review was to systematically present contemporary evidence on the diagnosis and management of acute scaphoid fractures. Methods: A literature search was conducted by the authors using the PubMed database and the following search terms: “[scaphoid (title/abstract)] AND [{fracture (title/abstract)} OR {fractures (title/abstract)}] AND [{management (title/abstract)} OR {treatment (title/abstract)} OR {diagnosis (title/abstract)} OR {evaluation (title/abstract)} OR {fixation (title/abstract)}].” Filters were applied to include human studies published between 2014 and 2023 in the English language. Results: Relevant research was identified and perused. Evidence was extracted from original research and systematic reviews. Conclusion: Data were charted manually, and the aggregated body of information was categorized, summarized, and presented systematically.

Update to Management of Acute Scaphoid Fractures.

The scaphoid is the most commonly fractured carpal bone. With high clinical suspicion and negative radiographs, expedient evaluation by CT or MRI has been recommended. When treating nondisplaced or minimally displaced scaphoid waist and distal pole fractures, immobilization below the elbow without inclusion of the thumb is an option. Comparatively, early surgical intervention for nondisplaced or minimally displaced scaphoid waist fractures allows for quicker return of function, but with increased risk of surgical complications and no long-term outcomes differences compared with cast immobilization. For most patients with such fractures, consideration for aggressive conservative treatment involving 6 weeks of immobilization with CT assessment to guide the need for continued casting, surgical intervention, or mobilization is advocated. Determination of union is best done with a CT scan at 6 weeks and at least 50% continuous trabecular bridging across the fracture site deemed sufficient to begin mobilization. Nonsurgical and surgical management of scaphoid fractures requires a thorough understanding of fracture location, fracture characteristics, and patient-specific factors to provide the best healing opportunity of this notoriously difficult fracture and return the patient to full function.

Treatment of acute non-displaced scaphoid fracture of wrist with syringe needle-guided percutaneous cannulated headless hollow compression screw internal fixation

To investigate the clinical efficacy of needle-guided percutaneous cannulated compression screw fixation in the treatment of acute non-displaced scaphoid fracture of wrist. The clinic data of twenty-eight patients with acute non-displaced scaphoid fracture from January 2014 to January 2019 were analyzed retrospectively. According to the intraoperative method of placement of cannulated screw, they were divided into Guide group(16 patients)and Conventional group(12 patients). There were 13 males and 3 females in Guide group, aged from 20 to 60 years old with an average of(31.42±9.71)years old;5 patients were classified as type A2, 3 patients were classified as type B1 and 8 patients were classified as type B2 according to Herbert classification;they were treated with percutaneous cannulated compression screw fixation under the guidance of needle. There were 11 males and 1 female in Conventional group, aged from 23 to 61 years old with an average of(30.51±7.52)years old;5 patients were classified as type A2, 2 patients were classified as type B1 and 5 patients were classified as type B2 according to Herbert classification;they were treated with conventional percutaneous cannulated compression screw fixation. The operation time, screw angle relative to the longitudinal axis of the scaphoid and wrist function score were assessed and compared between the two groups. A total of 28 patients were followed up from 20 to 45 months with an average of (33.00±8.72) months. None of patients had intraoperative complication and incision infection. These patients returned to work gradually 2 weeks after operation, and all fractures healed within 12 weeks. The operation time in the Guide group was significantly less than that in the Conventinal group(P<0.05). Screw angle relative to the longitudinal axis of the scaphoid in the Guide group was significantly smaller than that in the Conventional group(P<0.05). There was no significant difference in Mayo wrist function scores at the last follow-up between the two groups(P>0.05). During the follow-up period, none of the 28 patients showed internal fixation displacement, arthritis, scaphoid necrosis and other complications. In the treatment of acute non-displaced scaphoid fractures, the operation time of needle-guided percutaneous cannulated headless compression screw fixation is significantly shorter than that of conventional percutaneous screw fixation, and the screw axis is easier to be parallel to the longitudinal axis of the scaphoid.

Magnesium-Based Compression Screws in Acute Scaphoid Fractures and Nonunions.

Magnesium-based bioabsorbable osteosynthesis material continues to receive increasing attention. The following study documents our experience with bioabsorbable magnesium screws in scaphoid fracture treatment in hopes to capture further evidence and successful application. Eight acute scaphoid fractures and four nonunions were treated with the magnesium-based bioabsorbable compression screw MAGNEZIX®. Objective outcome was assessed by X-ray imaging and/or CT scan for bone healing. Clinical assessment was achieved using the modified Mayo Wrist Score. Patient-reported outcome measure was performed threefold via QuickDASH, PRWE, and EQ-5D-5L questionnaires in all patients. Follow-up was 32.5months (SD 18.7) in the acute fracture group and 31months (SD 7.4) in the nonunion group. Bone healing was achieved in all eight patients with acute scaphoid fractures and in three of four patients with scaphoid nonunion. The modified Mayo Wrist Score was 95 (SD 7.1) in fractures and 80 (SD 7.1) in nonunion patients during follow-up. QuickDASH score was 3.9 (SD 5.8) in fracture and 19.3 (SD 10.6) in nonunion patients. All but one patient (87,5%) with scaphoid fractures presented with a full health state during follow-up (EQ-5D-5L). Nonunion patients had problems in 10 out of 19 dimensions in EQ-5D-5L. Acute fractures presented with a score of 3.9 (SD 7.9) and nonunions with a score of 19.7 (SD 32.4) in PRWE total scoring during follow-up. Magnesium-based implants have excellent clinical outcomes when used for scaphoid fractures in eight presented cases and good to moderate clinical outcomes when used for nonunions in three of four presented cases. Additional studies are required to further analyze the differentiated applicability in scaphoid nonunion as well as overall performance when compared to non-absorbable screws in larger cohorts.

Conservative Treatment Versus Percutaneous Fixation by Herbert Screw of Acute Non-Displaced Waist Scaphoid Fracture: A Randomized Controlled Clinical Trial

Conservative Treatment Versus Percutaneous Fixation by Herbert Screw of Acute Non-Displaced Waist Scaphoid Fracture: A Randomized Controlled Clinical Trial

Comparison of Conservative Treatment and Surgery Treatment for Acute Scaphoid Fracture: A Meta-Analysis of Randomized Controlled Trials.

This meta-analysis aimed to investigate the effectiveness of conservative and surgical treatments of scaphoid fracture. The literature databases of Pubmed, Cochrane library, and Embase were searched in March 2022. This work extracted the data based on healing time, grip strength, range of wrist motion, nonunion, time before returning to work, and complications (including persistent pain, malunion of the fracture, wound infection, scar sensitivity, hypertrophic scar, and implant-related complications). Stata 14.0 software was used for statistical analysis. Twelve RCTs studies met our inclusion criteria. The surgical group had a shorter healing-time and time before returning to work than the conservative group. In addition, the surgical group had significantly better grip strength and range of wrist motion than the conservative group (P < 0.01). However, there was no significant difference between nonunion (P = 0.538) and complications (P = 0.661) between the two groups. This meta-analysis showed that surgical treatment of scaphoid fracture achieved better grip strength and range of wrist motion, and had a lower healing time and time before returning to work than the conservative treatment. The two treatments had similar results in nonunion and complications. Further RCTs were required for the research.

Comparison of Two Different Percutaneous Screw Fixations for Treating Herbert B2-Type Acute Scaphoid Fractures.

Scaphoid fracture was the most common carpal fracture and the most challenging. The purpose of this study was to investigate and compare the clinical effects of closed reduction and percutaneous cannulated screw internal fixation under fluoroscopy and arthroscopy-assisted percutaneous cannulated screw internal fixation in the treatment of Herbert B2-type of acute scaphoid fractures. A retrospective controlled study was conducted on 29 patients with Herbert B2-type acute scaphoid fracture with a displacement of >1 mm admitted to our hospital from January 2017 to June 2021. Patients were divided into two groups, 11 patients were treated with closed reduction percutaneous cannulated screw internal fixation under fluoroscopy and 18 patients were treated with percutaneous cannulated screw internal fixation assisted by arthroscopy. The operative time, intraoperative fluoroscopy times, fracture healing time, complications, and postoperative wrist function score of the two groups were compared. All patients were followed up for 6-18months (mean follow-up duration: 10.38 ± 2.69months). The respective operation times in the arthroscopy group and fluoroscopy group was 51.50 ± 6.69 min and 56.73 ± 11.48 min, respectively (p > 0.05). The number of fluoroscopies performed in the arthroscopy group was (6.83 ± 1.30), which was less than that in the fluoroscopy group (10.91 ± 2.62) (p < 0.05). All fractures in the arthroscopy group healed after the operation, and the fracture healing time was 11.44 ± 1.25W. Ten patients in the fluoroscopy group healed. The fracture healing time was 13.60 ± 2.32 W. The fracture healing time in arthroscopy group was less than that in the fluoroscopy group (p < 0.05). One patient in the fluoroscopy group had nonunion and healed after bone grafting and internal fixation. At the postoperative 6-month follow-up, the modified Mayo wrist function score was used to evaluate the clinical results. The wrist function score of patients in the arthroscopy group was 90 (85, 95), which was >80 (80, 90) in the fluoroscopy group (z=2.74, p < 0.05). For Herbert B2-type acute scaphoid fracture with fracture displacement > 1 mm, the arthroscopy-assisted percutaneous cannulated screw internal fixation has less fluoroscopy times, short fracture healing time, and good recovery effect of wrist function compared to the fluoroscopy.

A Comparison Between Robotic-Assisted Scaphoid Screw Fixation and a Freehand Technique for Acute Scaphoid Fracture: A Randomized, Controlled Trial

We compared robotic-assisted scaphoid screw fixation to conventional technique in terms of accuracy, surgical times, radiation exposure, and clinical outcomes, including range of motion, grip strength, functional score, and complications. This study was a registered, prospective, randomized, controlled trial. From May 2019 to December 2019, 1 surgeon performed 18 robotic-assisted and 18 conventional scaphoid screw fixations and these patients were eligible for participation in this study. Surgical time, including the time of the overall procedure, set-up time, and time for ideal guidewire placement, was recorded. The number of guidewire attempts also was recorded. All patients were evaluated clinically and radiographically at follow-up with respect to the severity of pain, wrist motion, grip strength, complications, and Mayo modified wrist score. The average set-up time and overall time of the procedure were longer in the robotic-assisted than in the conventional groups, while the mean guidewire insertion time and the mean guidewire attempts was less in the robotic-assisted group than that of the conventional group. The overall radiation exposure was lower in the robotic group. Robotic-assisted technique provided a useful tool to improve implantation accuracy and shorten radiation exposure. Additional cost and prolonged duration of surgery without evidence of improved clinical scores may limit widespread acceptance of this technique. Therapeutic II.

Bone Morphogenic Protein-2 Use for the Surgical Treatment of Acute Scaphoid Fractures and Scaphoid Nonunions.

Bone morphogenic protein-2 has demonstrated promise as an adjunct to surgically treating fractures. Its reported use in the upper extremity is limited. This study reports union rates, outcomes, and complications of scaphoid fractures treated with adjunctive bone morphogenic protein-2 to further characterize bone morphogenic protein-2 use in the hand and wrist. Retrospective review of scaphoid fractures treated surgically in one region of the Military Health System from 2009 to 2019 was conducted to identify cases using bone morphogenic protein-2. Fracture healing was determined by computed tomography. Primary outcomes were union rate, time to union, and complications. Secondary outcomes included union rates for prior nonunions, union rates at 4 and 6 weeks, and functional outcomes. Fourteen patients met inclusion criteria. Nonunions accounted for 50 percent of included fractures. The total union rate was 93 percent. Mean time to union was 6.2 weeks. All acute fractures healed with a mean time to union of 4.8 weeks. Nonunions had a union rate of 86 percent, with a mean time to union of 7.7 weeks. Four patients (29 percent) developed radiographic heterotopic ossification; however, no significant decrease in motion was appreciated. Thirteen patients (93 percent) resumed the push-ups portion of the military fitness test. No major complications were identified during follow-up. Adjunctive use of bone morphogenic protein-2 in operative fixation of scaphoid fractures resulted in desirable union rates without major complications. Larger, prospective studies are needed to assess whether adjunctive bone morphogenic protein-2 use in scaphoid fractures provides significant benefit compared with other treatments. Therapeutic, IV.

Non-Displaced Scaphoid Waist Fractures: Percutaneous Screw Fixation Versus Cast Immobilization.

BackgroundScaphoid waist fractures make up 66% of scaphoid fractures and are mostly non-displaced. The purpose of this study was to demonstrate that percutaneous screw fixation is preferable to cast immobilization in the treatment of non-displaced or minimally displaced scaphoid waist fractures.MethodologyBetween 2017 and 2019, we conducted a retrospective review of patients aged 17-65 years who underwent treatment for acute non-displaced scaphoid waist fractures. In total, 52 patients with scaphoid waist fractures were included in the analysis, 25 of whom underwent percutaneous screw treatment and 27 were treated with a short plaster cast. Patient satisfaction, pain, range of motion, and grip strength were evaluated using the Mayo Modified Wrist Score (MMWS). In addition, the time to return to work/sports, union time, complications, and non-union status were evaluated.ResultsA total of 52 (35 male, 15 female) patients were enrolled in this study. The average follow-up time was 24.9 months (range, 24-29 months). The mean age was 28.12 years (range, 17-45 months). Group 1 consisted of 25 patients who underwent percutaneous screw fixation, and group 2 consisted of 27 patients who were treated with a short plaster cast. There were significant differences in return to work, return to sports, and union time between the two groups (p < 0.001). The sixth-month MMWS was significantly different between the two groups (p < 0.001), but the first-year MMWS was not significantly different between the two groups (p = 0.864). There were no complications in both groups.ConclusionsWith percutaneous screw fixation, acute non-displaced or minimally displaced scaphoid waist fractures demonstrated a high rate of union and early return to work/sports.

Study of Clinical and Radiographic Outcomes of Patients With Acute Scaphoid Fractures After Union

Background: There is no clear consensus on the best treatment option for scaphoid fractures. Objectives: In this study, we aim to evaluate the short-term clinical and radiologic outcomes in patients with acute isolated scaphoid fractures treated with surgical or nonsurgical methods. Methods: In a retrospective study, 31 patients with acute isolated scaphoid fracture (Mean±SD age: ‎28.9±9.9 ‎years) treated with open reduction and internal fixation (n=15) or cast immobilization (n=16) methods were included. The fractures were classified according to Herbert &amp; Fishers’ classification system. Clinical outcome measures were the wrist range of motion, pinch strength, and grip strength. Radiographic outcome measures were the lunocapitate angle, scapholunate angle, and ulnar variance. The outcome were compared between the involved and uninvolved hands and between surgical or nonsurgical groups. Results: The majority of fractures were type B2 (n=14). In a Mean±SD follow-up of 15.1±3.2‎‏ months, the mean extension, flexion, pinch, and grip strength of the involved hand averaged 81.3%, 80.7%, 90%, and 87% of the uninvolved hand. Accordingly, clinical outcomes were significantly lower in the involved hand. The scapholunate angle was significantly higher in the involved hand (P=0.002). Clinical and radiographic outcomes were not significantly different between the surgical and nonsurgical groups. Radiographic malalignment was detected in 25 scaphoids. No significant correlation was found between the clinical and radiographic outcomes. Conclusion: After scaphoid fracture union, the decrease in wrist range of motion (extension, flexion) and grip/pinch strength has no correlation with radiographic results.

Comparison between navigated and conventional percutaneous screw fixation of non-displaced scaphoid fractures

Incorrect screw placement and penetration in screw fixation of scaphoid fractures are found in 5 to 30 %. Therefore, optimizing of screw placement is desirable, especially because an exact central position of the screw in the proximal fragment leads to a significant higher stability as a more peripheral position. 36 patients with an acute non-displaced scaphoid fracture were included in this randomized prospective study. 18 patients underwent navigated, the other 18 conventional percutaneous screw fixation of an acute non-displaced scaphoid fracture through a dorsal approach. Operation time and x-ray dose were measured. In both groups the position of the screw in the scaphoid was calculated on CT scans and compared with each other. Clinically, 17 patients with navigated and 11 with conventional percutaneous screw fixation with an average age of 52 resp. 43.2 years were available for follow-up examination including Krimmer- and DASH-score. All scaphoids healed within an adequate time. Two cases of navigated screw fixation have been converted to conventional percutaneous screw fixation. The average operation time in the navigated group was 83.2 minutes, in the conventional group 42.1 minutes. X-ray dose measured 106,5 ± 19,9cGy/cm2 in the navigated group and 45,6 ± 8,0cGy/cm2 in the conventional group. Screw penetration using an intraosseous compression screw (HSC) was observed in 5 conventionally fixed scaphoids, 4 distally (2,27 ± 1,47 mm), 1 proximally. In the navigated group there were 11 screw penetrations, 4 proximally (2,01 ± 0,81 mm) and distally (1,21 ± 0,64 mm), 3 distally (1,18 ± 0,44 mm), and 4 proximally (1,61 ± 0,57 mm). Axial screw position was more accurate in the conventional group. The 17 navigated patients averaged a Krimmer-Score of 83.6 and a DASH-score of 5,6 points at follow-up. The 11 conventional treated patients averaged a Krimmer-Score of 95 and a DASH-score of 8.0 points at follow-up. In this study navigated screw fixation of acute non-displaced scaphoid fractures was not superior to conventional percutaneous screw fixation, neither for screw position, screw penetration nor with respect to the clinical outcome.

BILATERAL SIMULTANEOUSLY TRAUMATIC FRACTURE OF THE SCAPHOID: A CASE REPORT

Despite scaphoid fractures are common, simultaneously bilateral scaphoid fractures are rare cases. Most fractures of the scaphoid, especially the nondisplaced fractures of the waist and distal part, are able to heal spontaneously with proper casting. Although the scaphoid fracture is commonly seen among patients who fell on their outstretched hands, those with a history of falling on both hands are rarely seen and bilaterality should not be overlooked. It may be necessary to review the treatment plan once again in bilateral cases. A 48-year-old male patient was referred to our hand surgery clinic with below elbow thumb spica cast on his right hand 3 days after trauma. When the detailed history was questioned, it was observed that the patient fell from a height of 8 meters, there was pain in his right hand when he was in the emergency room, and pain in his left hand began after he had left the emergency room. The patient’s X-ray and CT images for his both hands were obtained. Bilateral acute simultaneous nondisplaced scaphoid waist fractures were diagnosed and bilateral compression screw fixation was planned. However, patient didn’t accept the operation and bilateral below elbow thumb spica casts were applied. Complete union and normal wrist range of motion were achieved. The major challange of this case is the treatment because applying bilateral cast causes difficulties in performing his daily activities besides loss of work hours. Although, most of nondisplaced waist fractures can be treated with proper casting in bilateral cases surgical treatment is considered one step ahead from casting.

Dual-energy CT in the diagnosis of occult acute scaphoid injury: a direct comparison with MRI

ObjectivesScaphoid injuries occult on plain radiography often require further imaging for definitive diagnosis. We investigate the utility of dual-energy computed tomography (DECT) for the detection of acute bone marrow oedema and fracture of scaphoid compared to MRI.Materials and methodsTwenty patients who presented acutely (without prior injury) to the emergency department with clinically suspected occult scaphoid fracture and had MRI of the wrist were prospectively recruited to have DECT (GE Revolution CT). Material decomposition images of the water-calcium base pair were generated and assessed in conjunction with the monochromatic images to permit correlation of marrow signal changes with any cortical disruption for fracture confirmation. The assessment was performed by two musculoskeletal radiologists blinded from MRI results. The statistical difference of MRI and reviewers’ detection of acute bone oedema (1 = present, 0 = absent) was performed using the Friedman test (SPSS v.16).ResultsMRI showed acute scaphoid fracture and/or bone marrow oedema in 14/20 patients of which 6 also had cortical disruption. On DECT, reviewer A identified oedema in 13 and cortical disruption in 10 patients while reviewer B identified oedema in 10 and cortical disruption in seven of the 14 MRI positive patients. No statistically significant difference in oedema detection on MRI and reviewers of DECT (p value 0.61) but DECT was more sensitive at detecting cortical disruption.ConclusionDECT has the capability to detect acute scaphoid oedema in addition to cortical fractures. However, compared to MRI, DECT has lower contrast resolution and less sensitive in the detection of mild oedema.Key Points• Dual-energy CT is able to detect acute traumatic scaphoid marrow oedema.• Dual-energy CT has greater detection rate of scaphoid fractures than MRI.• Dual-energy CT is an alternative to MRI for occult scaphoid injury.

Diagnostic and Therapeutic Approach to Acute Scaphoid Fractures

AbstractThe scaphoid is the carpal bone that most often fractures, accounting for up to 70% of carpal fractures and 11% of hand fractures. It is the second most common arm fracture, only surpassed by fractures of the distal radius. Despite being so common, these fractures can be difficult to diagnose and treat due to the anatomic and physiological particularities of the bone, including its precarious vascularization, its complex three-dimensional structure, and its ligament connections, which greatly contribute to the risk of complications such as malunion, pseudoarthrosis and avascular necrosis. Although there are many published studies on the treatment of these injuries, there is still controversy over what is the most suitable one for certain fracture types. The present article is a comprehensive and updated review of the literature. Combining strategies for clinical and radiological diagnosis, we propose a complete algorithm for the diagnosis of scaphoid fractures based on the varying availability of resources, and we also describe the most appropriate therapeutic approach for the different types of acute fractures of this bone.

Results of Percutaneous Fixation of Acute Scaphoid Fractures by Herbert Screw

Background: The Scaphoid bone is the tmost commonly fractured carpal bone. Proper clinical examination and radiological imaging is essential for early diagnosis and management. The management of scaphoid fractures varies from cast immobilization to open reduction and internal fixation. This paper explores the outcome of using headless cannulated screws in minimally displaced scaphoid fractures. Objective: Aim of this study is to assess the functional and clinical outcome of using cannulated headless screws in management of acute scaphoid fractures. Methods: A prospective study held between February 2019 and January 2020, where eighteen patients included with acute scaphoid fractures of Herbert B1, B2 and B3 classification. Fixation was done using both volar and dorsal percutaneous technique. Patients were evaluated postoperatively clinically using modified Mayo wrist score (MMWS). Results: Of mean age 34.5±8.37 years, the majority were with excellent final outcome (83.3%), good (5.6%), fair one case (5.6%) and only one poor (5.6%) and mean time of union was 9.66±1.9 months. Conclusion: All active young individuals with acute non-displaced or minimally displaced scaphoid fractures should be offered percutaneous internal fixation, for the sake of earlier gain of motion of the wrist, earlier time to union, quicker return to activity of daily living, and a lower complication rate.

Results of Percutaneous Fixation of Acute Scaphoid Fractures by Herbert Screw

Background: The Scaphoid bone is the tmost commonly fractured carpal bone. Proper clinical examination and radiological imaging is essential for early diagnosis and management. The management of scaphoid fractures varies from cast immobilization to open reduction and internal fixation. This paper explores the outcome of using headless cannulated screws in minimally displaced scaphoid fractures. Objective: Aim of this study is to assess the functional and clinical outcome of using cannulated headless screws in management of acute scaphoid fractures. Methods: A prospective study held between February 2019 and January 2020, where eighteen patients included with acute scaphoid fractures of Herbert B1, B2 and B3 classification. Fixation was done using both volar and dorsal percutaneous technique. Patients were evaluated postoperatively clinically using modified Mayo wrist score (MMWS). Results: Of mean age 34.5±8.37 years, the majority were with excellent final outcome (83.3%), good (5.6%), fair one case (5.6%) and only one poor (5.6%) and mean time of union was 9.66±1.9 months. Conclusion: All active young individuals with acute non-displaced or minimally displaced scaphoid fractures should be offered percutaneous internal fixation, for the sake of earlier gain of motion of the wrist, earlier time to union, quicker return to activity of daily living, and a lower complication rate.

A novel percutaneous achievement and maintenance of reduction and screw fixation for acute displaced scaphoid fractures: minimum two-year follow-up.

The purpose of this study was to introduce a novel method of percutaneous achievement and maintenance of reduction for acute displaced scaphoid fractures and evaluate the feasibility of this method in treating acute displaced scaphoid fractures as well as explore its indications. From February 2012 to March 2014, 15 patients with acute displaced scaphoid fractures were treated with our technique. Two Kirschner wires were used to achieve and maintain the reduction of the scaphoid fractures throughout the entire process of the traditional percutaneous screw fixation process. The following parameters including function scores according to modified Mayo wrist scoring system, range of motion (ROM) of the wrist, grip strength, pinch strength, healing time, time to return to work, and final outcomes were recorded. All patients were followed up with a mean period of 2.5years (range, 2-3.5years). All fractures healed with a mean of 9.3weeks (range, 7-11.5weeks). All patients returned to pre-injury level of activity within sixweeks. The functional scores averaged 90.3 (range, 80-100). ROM of the wrist was equal to that of the contralateral side at threemonths postoperatively. Grip strength and pinch strength compared with contralateral were 98% and 92%, respectively. All were satisfied with the final outcomes. Our technique is successfully performed in acute displaced scaphoid fractures resulting in shortened immobilization and prompt functional recovery. It broadens the indications of the percutaneous method, which means the advantages of the percutaneous method are maximally reserved whilst the drawbacks of open reduction were avoided.

Digital Tomography for Detection of Acute Occult Scaphoid Fractures.

Diagnosis of occult scaphoid fractures remains a challenge. Traditional management consisting of 2 weeks of immobilization and repeat radiographs results in unnecessary immobilization of many patients without fracture. Magnetic resonance imaging (MRI) is sensitive but expensive. Digital tomography (DT) is an imaging technique that provides fine-cut visualization with minimal radiation exposure and may be used when there is high clinical suspicion despite negative findings on initial radiographs. The authors compared the ability of DT vs MRI to detect acute occult scaphoid fractures. This was an institutional review board-approved, prospective series. Adults for which clinical suspicion for acute scaphoid fracture (presenting within 96 hours of trauma) and negative findings on initial radiographs existed were included. Both a wrist tomogram and MRI were obtained. Wrists were immobilized and reevaluated at 10 to 14 days with repeat radiographs as a control. Studies were interpreted by a radiologist in a blinded fashion. Forty consecutive extremities in 39 patients met the inclusion criteria. Six (15%) of the 40 scaphoids were determined to be fractured on repeat radiographs. Digital tomogram yielded positive findings in 4 of these. Magnetic resonance imaging yielded positive findings in 8 (20%) of the 40 extremities. Sensitivities were 67% and 100% for digital tomogram and MRI, respectively (P=.0001). The positive predictive value was 100% for DT and MRI. The authors found that DT detects more occult scaphoid fractures than initial standard radiographs but is less sensitive than MRI. This is the first study to compare DT with MRI. Digital tomography can be used to augment radiographs and may increase diagnostic efficiency, minimize unnecessary immobilization, and reduce health care costs. [Orthopedics. 2017; 40(6):e1092-e1095.].