Acute Scaphoid Research Articles

Acute percutaneous scaphoid fixation using a non-cannulated Herbert screw.

Conservative treatment of fractures of the scaphoid often leads to an important physical and economic morbidity, especially in the young and active population. Acute percutaneous scaphoid fixation is a fast technique with minimal soft tissue damage, which allows immediate mobilisation without prolonged casting. We describe our operation technique in which we always use a non-cannulated Herbert screw. We place the screw freehand and always pass through the trapezium, a technique which is in our hands the best way to place the screw in the right position. It is not technically demanding, but has a considerable learning curve and requires a three-dimensional knowledge of the scaphoid. We reviewed the results of 44 patients treated in our centre between 1996 and 2001. Comparing with literature of percutaneous scaphoid fixation, we found similar results. Although in literature this technique is only indicated for minimally and non-displaced fractures of the waist (Herbert A2 and B2), we describe some good results with proximal pole fractures. Nevertheless we found that all cases of delayed and non-union occurred with this type of fracture.

Percutaneous cannulated screw fixation of acute nondisplaced scaphoid waist fractures

Percutaneous screw fixation of acute, stable, scaphoid waist fractures has recently gained popularity secondary to the rapid fracture healing and decreased time off work/sports compared with cast immobilization. The historical background, pertinent anatomical considerations, and surgical technique of volar percutaneous cannulated screw fixation will be described. Additionally, the advantages of this technique over cast immobilization and open surgical stabilization methods will be reviewed. Although technically demanding, percutaneous cannulated screw fixation of scaphoid fractures provides rigid stabilization, faster union rates, and earlier return to work or sports. It is an attractive alternative to cast immobilization of acute, stable, scaphoid waist fracture in patients who understand the risks and benefits of this technique.

Treatment of Acute Scaphoid Fracture by Percutaneus Acutrak Screw Insertion

Purpose : The purpose of this study was to investigate the efficasy of dorsal percutaneous Acutrak screw fixation for acute stable or unstable scaphoid fractures. Materials and Methods : We assessed 7 cases of acute scaphoid fracture from January 2001 to Febrary 2002, 5 cases were of acute stable fracture (Herbert type A2) and 2 cases were of unstable minimal displaced fracture (Herbert type B2). All were treated by dorsal percutaneous Acutrak screw fixation. The postoperative management protocol involved removing the splint at postoperative 1 week, this was followed by active and strengthening exercise. Patients returned to work at a postoperative 2 weeks, and a follow-up study 7 cases from 12 to 20 months (average 15.8 months). Results : According to tenderness at the anatomical snuff box, pain during range of motion of the wrist joint and the Maudsley scale, 6 cases (Herbert type A2: 5 case, Herbert type B2: 1 case) were excellent and one case (Herbert type B2) was good. Conclusion : Dorsal percutaneous Acutrak screw fixation is useful method for acute stable or minimal displaced scaphoid waist fractures, because it reduces complications due to prolonged cast immobilization.

ARTHROSCOPIC AIDED FIXATION OF SCAPHOID FRACTURES

Acute nondisplaced scaphoid fractures have traditionally been managed with cast immobilization. Although cast immobilization may be successful in approximately 90% of cases, prolonged casting may lead to muscle atrophy, joint contracture, disuse osteopenia, and potential financial hardship. An athlete or worker may be inactive for 6 months or longer as the fracture heals. Arthroscopic assisted fixation offers a middle ground between traditional cast immobilization and open reduction for scaphoid fractures. These techniques reduce exposure and minimize soft tissue dissection with potential loss of vascularity, avoid division of the important radioscaphocapitate ligament, and allow for detection and management of any associated intracarpal soft tissue injuries. This article presents the indications and describes in detail the various applications for wrist arthroscopy in management of scaphoid fractures.

Percutaneous Cannulated Screw Fixation of Acute Scaphoid Fractures

Percutaneous Cannulated Screw Fixation of Acute Scaphoid Fractures

Retrograde compression screw fixation of acute proximal pole scaphoid fractures.

Seventeen consecutive patients with acute unstable proximal pole scaphoid fractures were managed over the past 5 years with open reduction and internal fixation. Four fractures were displaced, with greater than 1 mm of fragment offset and intercarpal malalignment. The operative technique consisted of a dorsal approach to the scaphoid, radius bone grafting, and freehand retrograde Herbert compression screw fixation. The patients were evaluated at an average of 37 months (range, 12-63 months) after surgery. All fractures healed within 13 weeks (average, 10 weeks). Functional wrist range of motion and grip strength were achieved in all patients. No patients developed osteonecrosis or radioscaphoid arthritis. Open reduction and internal fixation rather than primary casting is a better means of reducing the complications of delayed union, nonunion, and irreparable osteonecrosis that often occur after acute proximal pole scaphoid fracture treated with cast immobilization.

Acute percutaneous scaphoid fixation: F. S. Haddad and N. J. Goddard (Royal Free Hospital, London, UK)

Acute percutaneous scaphoid fixation: F. S. Haddad and N. J. Goddard (Royal Free Hospital, London, UK)

Acute percutaneous scaphoid fixation using a cannulated screw

Fractures of the scaphoid are most commonly seen in young males where immobilisation in a cast will lead to a prolonged period away from work and from athletic activities. Early rigid fixation has recently been advocated to promote a rapid functional recovery. Open reduction and internal fixation of the scaphoid is however technically demanding, damages the anterior radiocarpal ligaments, violates the scapho trapezial joint, further endangers the already compromised blood supply of the scaphoid and not infrequently leads to troublesome hypertrophic scars. These problems can be overcome in minimally displaced or undisplaced fractures by percutaneous fixation. We present the first 50 cases from our ongoing study of patients treated acutely in this way. No cast immobilisation was used and the patients were allowed to mobilise immediately postoperatively. Union was obtained in all cases after an average of 55 days (37-79). Range of movement at the time of fracture union was equal to that of the contralateral limb at three months and grip strength was 98% of the contralateral side at three months. Patients returned to sedentary work within 4 days and to manual work/sports within 5 weeks. We have found percutaneous scaphoid fixation for acute fractures a rapid and very satisfactory intervention which leads to a rapid functional recovery.

Acute percutaneous scaphoid fixation. A pilot study.

Fractures of the scaphoid are most common in young men; immobilisation in a cast usually means a long period away from work and athletic activities. Early rigid fixation has been shown to promote a rapid functional recovery, but open reduction and internal fixation is technically demanding with the dangers of damage to the radiocarpal ligaments, the scaphotrapezial joint, and the blood supply of the scaphoid. For minimally displaced or undisplaced B1 or B2 fractures, these problems can be overcome by percutaneous fixation. We report our technique and the results of a pilot study in 15 patients. There was no immobilisation; patients were allowed movement soon after operation, but union was obtained in all at a mean of 57 days (38 to 71). The range of movement after union was equal to that of the contralateral limb and grip strength was 98% of the contralateral side at three months. Patients were able to return to sedentary work within four days and to manual work within five weeks. Our initial results show that percutaneous scaphoid fixation for acute fractures is satisfactory and gives rapid functional recovery.

Day case acute percutaneous scaphoid fixation

Day case acute percutaneous scaphoid fixation

Internal fixation of acute stable scaphoid fractures in the athlete.

Our study evaluated the results of surgical repair of acute carpal scaphoid fractures in athletes and the time required for the athletes to return to play. Although playing casts are a nonsurgical option, they reduce the effectiveness of the athlete in sports that require maximal manual dexterity; thus, the management of scaphoid fractures is challenging when early return to sports is desired. Twelve athletes with 12 acute midthird scaphoid fractures were treated with Herbert screw fixation. All patients were in-season athletes in sports that precluded the use of a playing cast. Return to sports averaged 5.8 weeks. Nine of the 12 athletes had range of motion equal to the uninjured side. The grip strength was equal to the unaffected side in 10 of the 12 athletes. Clinical and radiographic union was evident in 11 subjects at an average followup of 2.9 years. The healing rates were comparable with other treatment modalities. We concluded that internal fixation of a scaphoid fracture allows safe and early return to sports when a playing cast is not an acceptable option and when an athlete accepts the risks of surgery.

Treatment of Acute Scaphoid Fracture

Treatment of Acute Scaphoid Fracture

Acute compression fracture of the scaphoid

A previously unreported radiological sign of a sclerotic margin to an acute displaced scaphoid fracture due to bone compression is reported. This should to be recognized because of the implied bone loss and hence risks of both mal-union and non-union, and because of the implication that volar compression fractures of the scaphoid, may occur.

Scaphoid fracture: A new method of assessment

The value of colour flow Doppler ultrasound scanning in patients with suspected acute carpal scaphoid fracture has been examined. A prospective study of 78 patients with signs and symptoms of carpal scaphoid injury was undertaken over a period of 6 months. Both wrists of all patients were scanned within 12-72 h of injury. The radial artery and carpal scaphoid bone contours are visible using this type of imaging technique. The distance between the medial wall of the radial artery and the outer cortex of the scaphoid waist was measured. The scaphoid index is described and was calculated from this measurement. Patients were managed without knowledge of the ultrasound imaging result, using plain radiographs and clinical examination as the standard for determining the presence of a scaphoid fracture. All patients were followed to the resolution of symptoms. All 12 patients who were subsequently considered to have scaphoid fractures were identified using this imaging technique within 12-72 h after injury. We conclude that this imaging may be useful in the assessment of patients with carpal scaphoid fracture. It can be used early, as a supplementary investigation, in patients with suspected carpal scaphoid fracture in whom the initial plain radiographs are normal.