Management Of Acute Scaphoid Fractures Research Articles

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.

Scaphoid fracture and nonunion: new directions.

The scaphoid is the largest of the carpal bones, articulating with both proximal and distal carpal rows. If scaphoid fractures are not appropriately diagnosed and treated, there is a risk of nonunion, osteonecrosis and degenerative arthritis. Operative management of the scaphoid fracture is primarily determined by the fracture location and amount of displacement. There is increased momentum for dual screw fixation constructs, intended to provide greater stability and reduce the risk of nonunion. Our current practice is to utilize two screws without graft as a first-line treatment for scaphoid nonunion with or without humpback deformity and cyst formation. This review will discuss the management of acute scaphoid fractures and the treatment of nonunion.

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.

Acute scaphoid fractures: making decisions for treating a troublesome bone.

Seven aspects of the management of acute scaphoid fractures are open to debate: Diagnosis of true fractures among suspected fractures, assessment of fracture displacement, cast immobilization strategies, the role of surgical fixation, proximal pole fractures, assessment of union, and the underlying objective of treatment. We reviewed current evidence, and our varied interpretations of it, to highlight areas of uncertainty where more evidence might be helpful.

Management of acute scaphoid fractures: a pragmatic approach for the non-specialist.

Scaphoid fractures are common and can cause significant morbidity if treated incorrectly. Thus, a working knowledge of the initial assessment and management of scaphoid fractures by non-specialists is crucial to allow quick diagnosis and avoid potentially catastrophic complications of scaphoid fracture. This article summarises the anatomy of the scaphoid, discusses methods to assess for scaphoid fractures and delineates management plans (conservative or operative) for fractures of the scaphoid based on location of vascular compromise. This article can also help the clinician predict which fractures may not unite with conservative management and therefore need referral to a specialist orthopaedic surgeon for possible surgery.

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.

Acute scaphoid fractures and non-unions

The diagnosis of scaphoid fractures requires a high index of suspicion, with a focus on the mechanism of injury and careful clinical examination. A scaphoid series of radiographs is required but if negative does not rule out a fracture. If there is clinical suspicion for fracture, one should obtain an MRI scan, which has the highest sensitivity and specificity for diagnosis. The management of acute scaphoid fractures is dependent largely on fracture location and displacement, although there are other factors to consider. On the whole, distal pole fractures can be managed conservatively and proximal pole fractures surgically, as the latter have poorer healing potential with a risk of avascular necrosis, due to a retrograde blood supply. The controversy lies with scaphoid waist fractures. One should consider surgical management for displaced waist fractures. The surgical approach is dependent on the fracture location and the surgeon's individual preference. Scaphoid non-union predictably leads to arthritis of the wrist, and therefore should be managed upon diagnosis. Reconstructive surgery provides the best outcomes, and more research is required into conservative treatments. Recent times have seen an increase in the use of vascularized bone grafts. In cases where there is established arthritis, salvage options include scaphoidectomy with four-corner fusion, proximal row carpectomy, total wrist arthroplasty and arthrodesis.

Current management of acute scaphoid fractures: a review

The aim of this review was to present currently available evidence on the management of acute scaphoid fractures. Acute scaphoid fractures are usually diagnosed by a combination of history, physical examination, and radiography. However, in many patients scaphoid fractures are still missed. Thus, the general trend is to over-treat patients with a suspicion of scaphoid fracture. Many aspects of scaphoid fracture management are still controversial and different institutions vary in their approach.

Revolutionize it - Time for big change.

Revolutionize it - Time for big change.

The assessment and management of acute scaphoid fractures and non-union

Abstract The management of scaphoid fractures can be challenging. The diagnosis of a fracture should be made following a suggestive mechanism of injury, positive clinical findings and confirmatory radiographs. In the case of normal radiographs the patient should be immobilized and re-examined in 2 weeks. If a scaphoid fracture is still clinically suspected but repeat radiographs are normal, further imaging is indicated. The gold standard is an MRI scan, but this is dependent on the facilities available in the local hospital. An MRI has the added benefits of not only identifying a potential scaphoid fracture but also other causes for the symptoms such as a ligament injury. Stable fractures can be safely treated by immobilizing in a cast; usually a simple below elbow cast with the wrist in slight extension and the thumb left free is adequate. If a patient elects to have a proximal pole fracture treated non-operatively then the thumb should probably be included. The cast should be continued for a maximum of 12 weeks and then removed regardless of clinical or radiological features. Surgical treatment should be considered for unstable fractures of the scaphoid, which includes displaced waist and proximal pole fractures. The surgical approach will depend upon the fracture location and preference of the individual surgeon. Compression screws should be used whenever possible. There are occasions in which fixation of undisplaced waist fractures using percutaneous techniques may be beneficial and this should be considered on a case-by-case basis. The management of scaphoid non-unions can be daunting and controversial. The best treatment of non-unions is to prevent them from developing by identifying those fractures which are unlikely to unite and treating them properly acutely. Whilst the development of non-union can be anticipated in approximately 10% of all fractures, it is more common in proximal fractures, displaced fractures, comminuted fractures, and those which have a delayed presentation. The decision of who and when to treat can be difficult and the patient must be involved in this process. Once it is decided that operative treatment is necessary the available options depend upon the presence of arthritis and the blood supply of the proximal pole. Union is most reliably achieved with a cortico-cancellous bone graft and headless compression screw fixation. If avascular necrosis (AVN) is evident then the best results are achieved with a vascularized graft. Despite grafting 20% will still not unite and a salvage procedure may prove necessary.

An Evidence-Based Approach to the Management of Acute Scaphoid Fractures

Current opinion favors operative treatment of displaced scaphoid fractures as it has been recognized that displaced fractures are at a higher risk of malunion and/or nonunion.1 The role of surgical fixation for undisplaced scaphoid waist fractures is more controversial. Proponents of operative fixation cite a quicker return to activity (work/sport) and a reduced risk of nonunion compared with that for cast treatment and with minimal additional risk.