Nondisplaced Scaphoid Fractures Research Articles

Cannulated Variable Pitch Compression Screw Fixation of Scaphoid Fractures Using a Limited Dorsal Approach

Scaphoid fractures are common in the young, active patient. Treatment is challenging because of the complex three-dimensional anatomy of the scaphoid and the tenuous blood supply. Traditionally, cast immobilization has been used for the management of non-displaced fractures with satisfactory outcomes reported in the literature. However, non-surgical treatment may result in a delayed union or nonunion particularly if the fracture is unstable, displaced, or involves the proximal pole. Recently there has been increased interest in the fixation of non-displaced scaphoid fractures. The proposed advantages for operative treatment include avoiding the morbidity and inconvenience of prolonged cast immobilization and a lower incidence of delayed union or nonunion. A variety of surgical approaches for fixation of an acute scaphoid fracture have been described. The most common techniques include percutaneous fixation, arthroscopically assisted reduction and fixation, or open reduction and internal fixation via a volar approach. The senior author favors a limited dorsal approach with compression screw fixation of all proximal pole fractures as well as displaced and non-displaced fractures of the waist region. The technique is simple permitting accurate screw placement in the central axis of the scaphoid, which is biomechanically advantageous and important for achieving union.

Methods of Cast Immobilization for Nondisplaced Scaphoid Fractures and the Evaluation of Fracture Union

Methods of Cast Immobilization for Nondisplaced Scaphoid Fractures and the Evaluation of Fracture Union

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.

Management of acute and chronic scaphoid fractures

The scaphoid is the most frequently fractured carpal bone. Typically, the injury affects young active males and results from a fall on the outstretched hand. The pivotal role played by the scaphoid in carpal mechanics is suggested by the severe wrist disability that may follow unrecognized or unsuccessfully treated scaphoid fractures. The large majority of acute scaphoid fractures are successfully treated by cast immobilization. Traditionally, open reduction and internal fixation has been reserved for acute fractures characterized by displacement, angulation, or instability. Many surgeons now advocate surgical stabilization for nondisplaced scaphoid fractures, especially proximal pole fractures, in an attempt to diminish the incidence of “cast disease,” delayed union and nonunion. In the case of established symptomatic nonunions, bone grafting with internal fixation is indicated if there is no significant arthrosis. The donor graft is determined by structural and vascular considerations. Recent studies have focused on the following: 1) the usefulness of various imaging modalities for diagnosing occult fractures, characterizing fracture configuration and related injuries, and identifying avascular necrosis; 2) treatment algorithms for a variety of patient groups including those with specific occupational or professional needs and children; 3) the stratification of treatment in cases of nonunion based on scaphoid vascularity and other factors; and 4) the identification and correction of rotational and angulatory deformities associated with scaphoid malunions.Curr Opin Orthop 1999, 10:271–276© 1999 Lippincott Williams & Wilkins, Inc.

A review of scaphoid fracture healing in competitive athletes.

A fractured scaphoid is a common disabling injury occurring in contact sports. Plaster immobilization is the most frequently used form of therapy. However, the rules governing most amateur sports do not allow an unyielding form of immobilization distal to the elbow. We describe a method of treating scaphoid fractures with custom-made Silastic (Dow Corning Wright, Arlington, TN) casts for competitive athletes. A retrospective review of 14 scaphoid fractures occurring in athletes competing in contact sports was completed to determine if effective immobilization could be maintained with this technique. The study covered a 10 year period with an average followup of 3.9 years (range 2 to 9 years). Ten of 11 middle third scaphoid fractures healed uneventfully. One nonunion occurred following a 7 week delay in diagnosis. Two of three proximal third scaphoid fractures went on to nonunion, while the third healed after a prolonged period of treatment. Our data indicate that nondisplaced middle third scaphoid fractures can be effectively immobilized for competition in contact sports with the custom-made Silastic cast described.