Clinical and radiological outcome of cast immobilisation versus surgical treatment of acute scaphoid fractures at a mean follow-up of 93 months

Abstract

We report the outcome at a mean of 93 months (73 to 110) of 71 patients with an acute fracture of the scaphoid who were randomised to Herbert screw fixation (35) or below-elbow plaster cast immobilisation (36). These 71 patients represent the majority of a randomised series of 88 patients whose short-term outcome has previously been reported. Those patients available for later review were similar in age, gender and hand dominance. There was no statistical difference in symptoms and disability as assessed by the mean Patient Evaluation Measure (p = 0.4), or mean Patient-Rated Wrist Evaluation (p = 0.9), the mean range of movement of the wrist (p = 0.4), mean grip strength (p = 0.8), or mean pinch strength (p = 0.4). Radiographs were available from the final review for 59 patients. Osteoarthritic changes were seen in the scaphotrapezial and radioscaphoid joints in eight (13.5%) and six patients (10.2%), respectively. Three patients had asymptomatic lucency surrounding the screw. One non-operatively treated patient developed nonunion with avascular necrosis. In five patients who were treated non-operatively (16%) there was an abnormal scapholunate angle ( > 60 degrees ), but in four of these patients this finding was asymptomatic. No medium-term difference in function or radiological outcome was identified between the two treatment groups.

Interobserver variation in classification of malleolar fractures

“…Several authors remarked that interpretation of radiographs and use of classification systems is difficult [3,4,18]. Other authors advocate using a CT scan for severely injured ankles [19,20], particularly when a fracture of the posterior malleolus is present.…”

Analysis of Wrist Motion Following Vascularized Bone Graft to the Proximal Scaphoid

“…Scaphoid fractures treated surgically were reported to regain 86% to 98% of wrist motion compared to the uninjured side; these differences were not significant. [13][14][15][16][17][18] The decrease in wrist motion due to scaphoid fracture might be a result of the effects of scar formation and postoperative immobilization, which could not be assessed by this study.…”

Scaphoid fractures in the athlete

“…Scaphoid fractures treated with cast immobilization alone unite in 88 to 95% of cases [21][22][23]. The duration of cast treatment also varies depending on the fracture site.…”