Treatment Of Scaphoid Fractures Research Articles

Our Experience with Surgical Treatment of Scaphoid Fractures with Headless Compression Screw

BACKGROUND: Fractures of the scaphoid bone are quite common, and they come with their own set of challenges due to the specific shape of the fractures and the delicate blood supply to the scaphoid bone. Failing to diagnose and treat acute scaphoid fractures promptly can result in failure of the bone to heal and subsequent development of wrist arthritis. Advances in diagnosis, surgery, and implant materials have led to a growing inclination towards early surgical fixation, even for non-displaced scaphoid fractures that could potentially be treated without surgery. AIM: The study's goal was to assess the effectiveness of headless compression screws for treating acute scaphoid fractures and, in two cases, nonunion following previous conservative therapy. METHODS: Between January 2022 and March 2024 ten patients with scaphoid fractures were surgically treated at the University Clinic of Traumatology Skopje, within twelve months follow-up. All of them were male with mean age of 27,3 years. All were diagnosed with X-rays and CT scans. Six of the fractures were on the right hand and four on the left. RESULTS: All the patients were surgically treated with open reduction and internal fixation with headless compression screw. Volar approach was used in 9 cases and dorsal approach in only one of them. Six of the patients were surgically treated within 4-14 days after injury and four of them were surgically treated due to non union after previous conservative treatment, two of them after three and two of them after seven months of injury. All fractures united after a mean time of 9,5 weeks, without secondary displacement. Throughout the follow-up period, there were no incidences of developing osteoarthritis of the wrist. CONCLUSIONS: It is crucial to understand that achieving a positive result is not guaranteed for every patient and relies on selecting the right patients and fractures. However, our study shows favorable results in sooner surgical treatment with the headless compression screw, rather than delayed treatment of scaphoid fractures. Surgical treatment with headless compression screw showed both functional and radiographic results. While it is beneficial for the screw to be positioned in the subchondral area, it is important to be cautious to avoid cortical penetration, as this will require the screw to be removed later.

Volar locking and angular stability plate for treatment of comminuted scaphoid fractures: a case series of 44 cases.

The primary method employed worldwide for the treatment of scaphoid fractures is screw fixation. However, in unstable and comminuted fractures, percutaneous fixation could produce complications due to technical challenges, such as improper axis positioning, inaccurate screw length measurement, intra-articular screw penetration, and impingement. Alternative open approaches for the surgical management of scaphoid fractures have been proposed, and in recent years, a new specific volar locking plate for the treatment of scaphoid fractures has been developed. This study aims to present the outcomes of this technique applied to 44 patients with unstable and comminuted fractures of the scaphoid. The purpose of the study is to verify the effectiveness of the volar plate in the treatment of comminuted scaphoid fractures and the necessity for plate removal when consolidation has occurred. Between January 2021 and March 2023, a specific volar locking plate for the treatment of scaphoid fractures was used in 44 patients. A retrospective study was conducted involving all patients, consisting of continuous clinical and radiographic assessments, functional evaluations (using QuickDASH and MHQ), and patient satisfaction surveys. All patients achieved clinical and radiographic recovery. However, the plate can impinge with nearby structures and should be removed once the fracture is consolidated. After plate removal, further improvement in range of motion was observed. The plate and screws system is a viable and appropriate method of osteosynthesis in the treatment of unstable and comminuted recent fractures occurring in the middle third of the carpal scaphoid.

The Conservative and Operative Treatment of Carpal Fractures.

Carpal fractures (incidence: 30-60 per 100 000 persons per year) are one of the more commonly overlooked fracture types. They can have serious consequences, as the use of the hand is indispensable in everyday life. In the following article, we present the elements of the diagnosis and treatment of fractures of the carpal bones. This review is based on meta-analyses and randomized controlled trials (RCTs) published from 2013 to 2023 that were retrieved by a structured literature search, supplemented by guideline recommendations and expert consensus statements. In addition, data on the administrative prevalence of carpal fractures were obtained from the German Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung, KV) and from the German Statutory Accident Insurance (Deutsche Gesetzliche Unfallversicherung, DGUV). The administrative prevalence of carpal fractures in 2022 was 44 496 outpatient cases (KV, DGUV) in one year. After clinical history-taking, physical examination and x-ray have been performed, thin-slice computed tomography is recommended as part of the diagnostic evaluation. Treatment recommendations are based on evidence of levels II to IV. Multiple RCTs have been carried out on the treatment of scaphoid fractures, and a clinical guideline exists. Proximal, dislocated and unstable scaphoid fractures should be treated surgically. Non-displaced or minimally displaced fractures of the middle third of the scaphoid bone require a shorter period of immobilization with surgical treatment (2-4 weeks) than with conservative treatment (6-8 weeks). The use of plaster casts that do not hinder elbow and thumb mobility yields healing rates similar to those obtained with the immobilization of both of these joints. Failure to treat an unrecognized scaphoid fracture can lead to pseudarthrosis, avascular bony necrosis, and misalignment. Other, rarer types of carpal fractures must be managed on an individual basis, as the available evidence is limited to expert consensus. Early recognition and appropriate treatment of carpal fractures lead to healing in more than 90% of cases. Although the available evidence on their proper treatment is growing, many questions are subject to expert consensus, and decisions about treatment must be made individually.

PANORAMIC REVIEW OF ACUTE SCAPHOID FRACTURES: DESCRIPTION, EPIDEMIOLOGY, ETIOLOGY, PRESENTATION, DIAGNOSIS, TREATMENT AND PROGNOSIS

Introduction: Scaphoid fractures are the most common fractures of the carpal bone and commonly occur in young males. Inadequate treatment of these fractures commonly leads to pseudarthrosis, resulting in pain and significant disability. Tenderness to palpation and/or pain with axial loading of the thumb should be managed as if it were a scaphoid fracture until proven otherwise. Objective: to detail current information related to scaphoid fractures, description, epidemiology, etiology, presentation, diagnosis, treatment and prognosis. Methodology: a total of 37 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 20 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: fracture, scaphoid, carpal bones, trauma, surgery. Results: Scaphoid fractures account for 2% to 7% of all fractures and 60% to 70% of carpal bone fractures. They are infrequent in children with approximately 3% of all pediatric hand and wrist fractures. Non-displaced fractures have high healing rates with cast treatment. Radiographs may miss fractures up to 25% of the time. Physical therapy is important in both operative and nonoperative treatment. Conclusions: Knowledge of the clinical presentation, diagnosis and treatment of scaphoid fractures is of utmost importance, because sometimes this type of fracture can go undetected on radiographs, which can lead to complications such as pseudarthrosis. The diagnosis of scaphoid fractures is sometimes complicated, so when there is clinical suspicion, appropriate complementary examinations should be performed to better determine the pathological condition, as is the case of computed tomography. Conservative or surgical management will depend on the type of fracture. Smoking cessation is recommended to improve fracture healing and physiotherapy both after surgical and non-surgical treatment. KEY WORDS: fracture, scaphoid, carpal bones, trauma, surgery.

Surgical Treatment of Scaphoid Fractures: Recommendations for Management.

Background: Several operative treatments exist for scaphoid fractures, varying by approach (e.g., ercutaneous, volar, or dorsal), implant type (e.g., screw or Kirschner wire), and bone raft choice (e.g., none, nonvascularized, or vascularized). Many previous systematic eviews and meta-analyses have investigated outcomes following different surgicalÚpproaches, the use of vascularized versus nonvascularized bone graft for scaphoidßracture nonunions, and treatment for specific fracture patterns. However, given the advancements n scaphoid fracture treatment in recent years, there is a need for updated treatment recommendations hat would be beneficial to hand surgeons. Purpose: We present a comprehensive review of the operative treatment of scaphoid fractures based on recent literature and propose a unified treatment algorithm for managing these fractures. Methods: The English-language literature was searched from 2002 to 2023 for high evidence level (e.g., randomized trials), review, and meta-analysis articles with the following search terms: "scaphoid, "u8220"scaphoid" AND "nonunion, " and "scaphoid" AND "malunion. " Each article was creened by the authors to determine the scaphoid fracture scenario addressed and ubsequent treatment recommendations. The findings from article reviews were then rganized by scaphoid fracture types in this manuscript. Results: A total of 95 pertinent articles were ultimately selected and used as the basis for reviewing different scaphoid fracture scenarios. A treatment algorithm was then proposed based on literature review. Conclusion: This summary of the recent literature can guide hand surgeons in addressing scaphoidßractures. Future research in scaphoid fracture treatment, particularly for nonunions, would be most beneficial n the form of systematic review, meta-analysis, or multicenter prospective randomized clinical trials. Level of Evidence: IV.

Scaphoid Plate Osteosynthesis in Complex Fractures and Wrist Trauma: A Case Series.

Introduction Treatment of scaphoid fracture is challenging due to its unique blood supply and geometry. Traditionally, a headless compression screw is the standard treatment for unstable scaphoid fracture. Some fractures are complex, for example, comminution with bone loss. A scaphoid plate is an option in these difficult fractures providing adequate rotational stability. Aim To share our experience in using scaphoid plates in complex wrist trauma and comminuted fractures. Method and material Complex wrist trauma involving scaphoid fractures that were comminuted and multi-fragmentary fractures treated with plate osteosynthesis were retrospectively reviewed between July 2019 and September 2021. Patient demographic data, preoperative radiographs, CT scans, pain, wrist range of motion, and fracture union rate to union were reviewed. Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH®) score was recorded at 1-year postoperative follow-up. Results Nine patients associated with complex wrist trauma were included in this case series. The mean follow-up was 2.5 years (13-30 months). The union rate was 100%. The mean arc of motion was 105° (95-110°). QuickDASH® score was 19.96 at 1-year postoperative follow-up. Four patients had good outcomes, four satisfactory, and one poor outcome. One hardware complication was observed which was the impingement of the plate proximally over the articular surface of the distal radius. Conclusion A scaphoid plate is a reliable option for treating complex and difficult fractures. It provides adequate stability, especially in comminution, bone loss, or multi-fragmentary fractures which are not amendable using other fixation methods. We recommend the expansion of plate osteosynthesis beyond scaphoid nonunion into complex wrist trauma.

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.

Treatment of scaphoid fractures and pseudarthroses with the human allogeneic cortical bone screw. A multicentric retrospective study

BackgroundAllograft bone screws are rarely described for the fixation of the scaphoid. When fresh fractures are treated, metal screws are mainly used; when pseudarthrosis is the indication, plates in combination with vascularized or non-vascularized bone grafts are mainly used. The necessity of metallic screw removal is under debate, but it is mandatory for plates because of movement restrictions due to the plate. The use of biomaterials in scaphoid fracture fixation was described as leading to union rates of between 64 and 100%. Brcic showed the incorporation of an allogeneic cortical bone screw at 10 weeks postoperative, along with revascularization and stable osteosynthesis with primary bone healing, without any signs of immunological rejection. The purpose of this retrospective study was to explore the results obtained using an allogenic cortical bone screw (Shark Screw®) in patients with fresh scaphoid fracture fixation and pseudarthroses with respect to union rates and time to union.Patients and methodsWe retrospectively analyzed 75 patients: 31 with fresh fractures and 44 pseudarthrosis patients. The Shark Screw® was used for the fixation of the scaphoid in the fresh-fracture and pseudarthrosis patients. We evaluated the union rate, complication rate and time to union.ResultsUsing the human allogeneic cortical bone screw for scaphoid fracture fixation led to a high union rate (94–96%). There were two nonunions in the fresh fracture group and two nonunions in the pseudarthrosis group. The complication rate was 1.3% (1 patient). Median time to union was 16, 18 and 29 weeks for the fresh-fracture, pseudarthrosis and delayed-union patients, respectively. The treatment of fresh scaphoid fractures and pseudarthroses showed similar union rates to those described in the literature, uses a shorter and less invasive surgical method with no need for hardware removal, and has a low complication rate.ConclusionUsing the human allogenic cortical bone screw (Shark Screw®) led to similar union rates in fresh fractures—but better union rates in pseudarthrosis patients—compared to those presented in the literature for other scaphoid fracture fixation techniques, and it enabled a short and low-invasive procedure without any donor site morbidity and without the necessity to remove the hardware in a second surgery. The pseudarthrosis patient group showed a particularly strong benefit from this new procedure. The physiological bone metabolism remodels the cortical bone screw without scars.Level of evidence: III: retrospective cohort study, therapeutic investigation of a treatment.

To Determine Frequency and Outcome of Dyslipidemia in Diabetic Foot Patients

Background: After distal radius fractures, scaphoid fractures are the most prevalent kind of wrist fracture. Scaphoid fractures account for between 60 and 70 percent of all wrist fractures. Different treatment methods are used for their management. Objective: To determine the radiological outcome of percutaneous Herbert screw fixation in the treatment of delayed union and nonunion of the Scaphoid Methodology: The current study was descriptive study carried out at the orthopedic department, Qazi Hussain Ahmad Medical College, Nowshera from November 2021 to November 2022. All the relevant laboratory and radiological investigations were carried out for the enrolled patients. Under general anesthesia all the surgeries were performed. All the patients were followed up until union occurs. IBM SPSS version 23 was employed for analysis of data. Results: In our study, totally 40 patients were included. The male participants in our study were 32 (80%) whereas female participants were 8 (20%). The mean age of the patients was 27 (±4.7) years. The radiological union was achieved in all of our patients in 15.2 (±3.15) weeks. In Delayed union of scaphoid fracture patients the radiological union was achieved in 11 (±3.17) weeks while in nonunion scaphoid fracture patients, it was achieved in 19 (±4.32) weeks. Functional level was achieved in all the patients in 17 (±2.4) weeks. Based on postoperative complications, wrist stiffness was observed in 10 (25%) patients while osteoarthritis and osteonecrosis was not reported in any of our patients. Conclusion: Our study concludes that scaphoid fractures are effectively and conveniently treated by using Percutaneous Herbert screw fixations, which provides satisfactory functional and radiological result with few complications. We suggest the adoption of the Herbert screw for the treatment of scaphoid fractures in our hospital, regardless of whether the fracture has delayed union or is non-union, in order to achieve better radiological and functional outcomes. Keywords: Radiological outcome; percutaneous Herbert screw fixation; delayed union; nonunion

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.

Minimally Invasive Percutaneous Screw Guided by 3-Dimensional–Printed Guide for the Treatment of Scaphoid Fractures

This study aimed to explore the feasibility and efficacy of percutaneous fixation of minimally displaced scaphoid waist fractures using a 3-dimensional-printed guide in 10 cases. Fractures were examined using preoperative computed tomography. The skin interface and bone models were reconstructed using computed tomography data. Guidewire insertion was assisted by a guide. Computed tomography was performed 4-6 weeks after surgery until healing of the fracture was confirmed. The mean follow-up period was 7 months (range, 6-9 months). The fracture healing time, grip strength, flexion-extension arc, patient-rated wrist evaluation, and Mayo wrist score were recorded. A total of 6 hands were in the dominant limb. The mean operation time was 41 minutes (range, 32-70 minutes). Three (30%) scaphoids healed at 6 weeks after surgery, 8 (80%) scaphoids healed at 8 weeks after surgery, and 100% scaphoids healed at 12 weeks after surgery. After correcting for hand dominance, the mean grip strength was 84% (range, 71% to 95%) of that of the contralateral side. The flexion-extension arc was 97% (range, 82% to 100%) of that of the contralateral side. The mean Mayo wrist score was 95 (range, 85-100), and pain decreased to minimal levels. All patients returned to their preinjury activities. Three-dimensional printing is an effective and feasible technology that can help guide intraoperative processes. Therapeutic V.

An innovative technique - Axial Loading and Compression Fixation (ALCF Technique) of scaphoid fracture by percutaneous K-wire

Backgrounds Surgical fixation techniques used for the treatment of scaphoid fracture is still a topic of discussion among hand surgeons especially in terms of approach, implants and surgical techniques. We present an innovative technique of scaphoid fracture fixation by K-wire, which we accidentally encountered when the guide wire broke while doing a cannulated screw for the scaphoid. This technique of axial aligning, compression loading over a bent tip of K-wire across the fracture fragments of scaphoid is innovative. Materials The study included 16 patients operated for Scaphoid fracture between January-2017 to January-2020 by ALCF Technique. the patient age ranged from 18 to 69 years,M:F12:4, 13 fractures on dominant hand,10 fracture presented within 2 weeks, 7 were trans-scaphoid displaced fractures sustained in RTA, 3 proximal pole fractures sustained after a fall, 6 were delayed presentation more than 3 months. Method The technique used to pass a K wire from dorsally in ante grade fashion to align the fracture fragments along the anatomical axis of the scaphoid then bend the K wire at the proximal end so as to hook the proximal fragment. The distal end of the K wire is then applied manual traction load with gentle rotation to achieve compression at the fracture ends with rotational alignment on the distal fragment. The distal fragment is anvil on the proximal fragment by a K-wire binder before distally binding to achieve compression &amp; relative stable fixation. Conclusion It is a simple, easy to reproduce, economic method to achieve reduction, compression using axial traction and union in all types of scaphoid fractures.

Wrist angle measurements in predicting the presence of a displaced scaphoid fracture.

Early diagnosis and treatment of scaphoid fractures is critical to achieve union and prevent wrist degenerative arthritis. Plain radiographic measurements can guide the early approach to suspected fractures. Specifically, the ability to predict fracture or fracture stability from plain radiographs may allow the traumatologist to expand initial referral to three-dimensional imaging. We evaluated the ability of four measured angles to predict presence of a scaphoid fracture and stability. Fifty patients with a scaphoid fracture and 50 patients without fracture were evaluated for the cortical ring sign, scapho-lunate gapping, lateral scapholunate (SL), radio-scaphoid (RS), radio-lunate (RL), and radio-capitate (RC) angles by two-blinded observers. Measurement of an increased SL interval was associated with the presence of a scaphoid fracture as diagnosed on three-dimensional imaging [odds ratio (OR) 3.0, confidence interval (CI) 1.53-5.87, p = < 0.01]. The measured RL angle was associated with fracture displacement (OR 1.13, 95% CI 1.02-1.25, p = 0.02). Scapholunate gapping on plain radiographs in the context of a clinically suspected scaphoid fracture should increase suspicion for a fracture and may prompt earlier 3-dimensional imaging, while the presence of an abnormal radiolunate angle should increase wariness for instability and can be used in preoperative planning.

Robot-assisted vs traditional percutaneous freehand for the scaphoid fracture treatment: a retrospective study

PurposeThe purpose of this study was to assess the efficiency, safety, and accuracy of cannulated screw fixation using a robot-assisted method compared with a traditional percutaneous freehand method.MethodsThis retrospective clinical study included 18 patients with scaphoid fracture who underwent cannulated screw fixation by robot-assisted technique or traditional percutaneous freehand technique from June 2018 to June 2020. All patients were divided into the robot-assisted group (9 patients) or the traditional surgery group (9 patients). The operation time, blood loss, number of intra-operative fluoroscopies, fracture healing time, Mayo wrist function score, and screw implantation accuracy were recorded in the two groups.ResultsThe average age of the robot-assisted group was 37.9 ± 10.6 years (with a range of 30 to 52 years), there were eight males and one female, and there were six cases of scaphoid fracture on the right side and three on the left side. The average pre-operative time was 2.8 ± 0.7 days (ranging from 1 to 3 days). The average age of the traditional surgery group was 31.6 ± 6.8 years (with a range of 20 to 45 years), there were eight males and one female, and there were five cases of scaphoid fracture on the right side and four on the left side. The average pre-operative time was 2.1 ± 0.8 days (with a range of 2 to 4 days). The number of intra-operative fluoroscopies was 24.4 ± 3.5 in the traditional surgery group, whereas it was only 10.1 ± 1.9 in the robot-assisted group, which was significantly lower (P < 0.05). The average operation time of the traditional operation group was 48.4 ± 12.2 min, and that of the robot-assisted group was 32.6 ± 4.2 minutes, which was significantly shorter (P < 0.05). The angles between the actual screw position and the central axis of the scaphoid on both the coronal and sagittal post-operative CT images were 8.3° ± 2.3° and 8.8° ± 1.6° for the traditional operation group and 3.8° ± 0.8° and 4.3° ± 1.2° for the robot-assisted group, so the accuracy of the robot-assisted group was significantly higher (P < 0.05). There were no significant differences between the two groups in wrist function recovery or fracture healing time.ConclusionRobot-assisted treatment of scaphoid fracture is more accurate than traditional freehand technology, with shorter operation time and fewer intra-operative fluoroscopies. There is no difference between the two surgical techniques in intra-operative bleeding, post-operative fracture healing, or functional recovery. Robot-assisted surgery is a safe, effective, and accurate method for treating scaphoid fracture.

Effect of using a rehabilitation program in conjunction with the use of infrared radiation for a fracture of the scaphoid bone

LLLT is used for the treatment of scaphoid bone fracture. Laser energy is given as a dose of medicine with the right parameters and it is proved a blessing in the treatment of a scaphoid injury. The research aims to understand the use of the LLLT in the treatment of the scaphoid fracture. Also, clinical differences are observed while treating a group of patients. LLLT is performed with a laser diode with a wavelength of 905nm. At the end of the study, it is observed that the pain is decreased, the swelling is reduced and the range of the movement is increased in the patients. This study indicates that low-level laser therapy is an effective way of treatment for the scaphoid fracture. Moreover, when applied with a proper rehab program it increases the healing process of the bone.

Postoperative Immobilization of Scaphoid Fractures: A Comprehensive Review of the Literature.

The optimal protocol for postoperative immobilization following operative treatment of scaphoid fractures remains controversial. Reports of successful management with brief postoperative immobilization suggest that earlier restoration of function may be achieved by limiting the duration of immobilization. However, the risk of nonunion and its associated complications suggest that a more conservative approach with extended immobilization could optimize fracture healing. This paper presents a thorough review of the relevant literature and summarizes the myriad postoperative immobilization protocols and their reported outcomes. Postoperative immobilization protocols and reported outcomes for displaced, comminuted, and proximal pole fractures are discussed separately. The literature is reviewed following different operative techniques, including open reduction internal fixation and percutaneous screw fixation. Vigilant postoperative care of scaphoid fractures managed surgically is warranted to monitor for signs of nonunion while attempting to regain motion and strength to the injured wrist.

Conservative treatment of scaphoid fracture: Protocol for a systematic review

The scaphoid is the most commonly fractured carpal bone. Fractures affecting this bone affect young and active patients between 15 and 40 years of age. Stable scaphoid fractures are treated conservatively by plaster cast immobilization or other type of orthosis for an average period of four to 12 weeks. Failure to treat scaphoid fractures may result in avascular necrosis, nonunion, and early secondary osteoarthritis, which may result in significant economic and social impact due to the affected population, formed by young people of productive age. The management of this type of fracture varies significantly between different Institutions and orthopedic surgeons. This article describes a protocol for a systematic review that aims to evaluate the effects (benefits and harms) of conservative interventions in the treatment of scaphoid fractures in adults.

Treatment of Scaphoid Fractures and Nonunions

Treatment of Scaphoid Fractures and Nonunions

Intra-operative peri-articular cocktail injection in inflammatory arthritis patients undergoing total knee arthroplasty

&lt;p class="abstract"&gt;Surgical treatment of scaphoid fractures has evolved over the years to include variety of procedures and techniques. However scaphoid middle and distal third fractures fixation with Herbert screw by means of volar approach is a safe and effective method with good functional outcome and union rates. Our study concluded that management of middle and distal third scaphoid fractures with Herbert screw by volar approach gives excellent results in terms of union and recovery to daily activities. The wrist function improvement is more satisfactory, and the incidence of complications is low with this modality of treatment.&lt;/p&gt;

Evaluation of the mechanical properties and clinical application of nickel-titanium shape memory alloy scaphoid arc nail.

To investigate the mechanical and biomechanical properties of nickel–titanium (Ni–Ti) shape memory alloy scaphoid arc nail (NT‐SAN) fixator as well as study the surgical method of treating carpal scaphoid fractures and evaluate its clinical efficacy. (1) Static and dynamic bending tests with embedded axial bending fixture were conducted to study the mechanical properties. (2) To evaluate biomechanical strength and fatigue, 32 scaphoid samples were classified into four groups to perform the fixation rigidity test: intramedullary Kirschner fixation (group A), Kirschner straddle nail fixation (group B), screw nail fixation (group C), and NT‐SAN fixation (group D). Next, 24 scaphoid waist fracture models were classified to conduct fatigue experiments as follows: Kirschner straddle nail fixation (group E), screw nail fixation (group F), and NT‐SAN fixation (group G). (3) The Krimmer score chart was used for clinical evaluations. (1) NT‐SAN showed excellent mechanical performance and a long lifespan. (2) NT‐SAN was fixated with a strong intensity and an anti‐fatigue outcome. (3) Ninety‐eight interviewed patients were satisfied with the therapeutic effects of the arc nail (satisfaction rate: 95.92%). The designed strength and hardness of NT‐SAN corresponded with the anatomical characteristics of the scaphoid, and the designed mechanical properties met the biomechanical requirements of a scaphoid fracture. The fatigue strength can meet the requirements of bone healing after the scaphoid fracture. Clinical trials on NT‐SAN scaphoid fracture treatment have shown that the surgery is simple and the clinical results are satisfactory. The therapeutic level of NT‐SAN is III; thus, it is worth promoting.