Delays and Poor Management of Scaphoid Fractures: Factors Contributing to Nonunion

Wong, King Jye; Schroeder, Herbert P. von

doi:10.1016/j.jhsa.2011.06.016

Cited by 62 publications

(36 citation statements)

References 19 publications

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“…In contrast to this present study, the relationship between misinterpretation of symptoms and patient delay was not further evaluated. Wong et al reported a similar cohort of 96 patients, and found an even higher patient delay rate of approximately 60 %, with an average delay of 7.5 years [11]. Also this latter study did not assess specific factors associated with patient delay.…”

Section: Discussionmentioning

confidence: 87%

“…Also post-injury symptoms are often misinterpreted as a sprain by both patient and doctor [7]. A recent cohort study of scaphoid nonunion cases reported that more than 60 % of these patients did not seek medical attention within 24 h after their wrist injury and almost 50 % of these patients not within four weeks post-injury [11]. We had the impression that many patients with a scaphoid nonunion seek medical attention after a nonunion already has been established, ─by definition more than six months after the initial injury [12].…”

Section: Introductionmentioning

confidence: 99%

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Factors Associated with Patient Delay in Scaphoid Nonunions

et al. 2016

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Delay in seeking medical attention by patients, ─so-called patient delay, contributes to the relative high rate of delayed diagnosis and treatment in scaphoid nonunion cases. In this retrospective study we investigated the incidence of patients with a patient delay exceeding 6 months, thus by definition having an established nonunion. In addition to this, we investigated demographic, injury and patient related factors associated with this patient delay in scaphoid nonunion patients. We included 101 patients with established scaphoid nonunions treated surgically at our specialized hand surgery unit. Information regarding demographic and injury characteristics, and subjective patient related factors was obtained from medical records and a questionnaire-based survey. Sixty-four patients (63 %) responded to our survey. A quarter (25 %) of the patients showed a delay of more than 6 months. Demographic and injury characteristics were not related to this delay. In contrast to this, not attributing post-injury symptoms to a fracture but to e.g. a sprain instead, showed to be an independent predictor of patient delay. We report a high incidence of patients with an established scaphoid nonunion who delayed seeking medical attention. As there appears to be no demographic or injury characteristics associated with this patient delay, future developments of strategies to reduce patient delay should be targeted on all patients with a suspected scaphoid injury.

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Section: Discussionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Factors Associated with Patient Delay in Scaphoid Nonunions

et al. 2016

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“…It is important to include a complete description of the setting to allow the reader to know if the results of a particular study would generalize to their population. Only 2 papers used a flow diagram (9, 10). Flow diagrams provide an effective way to convey information about participants (8).…”

Section: Discussionmentioning

confidence: 99%

Using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement to Assess Reporting of Observational Trials in Hand Surgery

Sorensen¹,

Wojahn²,

Manske³

et al. 2013

The Journal of Hand Surgery

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Purpose To use the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement checklist to critically evaluate the change in quality of observational trial reporting in the Journal of Hand Surgery American between 2005 and 2011. Methods A cross-sectional analysis of observational studies published in Journal of Hand Surgery American was designed to sample 2 6-month periods of publication (March 2005 - August 2005 and June 2011 - November 2011). Fifty-one items were extracted from the STROBE statement for evaluation. Overall STROBE compliance rates for articles and specific checklist items were determined. Final compliance percentages from each period were compared by Student t-testing. Changes in item compliance over time were quantified. Results Overall compliance with the STROBE statement was 38% (range, 10-54%) in 2005 and 58% (range, 39%-85%) for 2011 manuscripts representing a significant improvement. Seventy-five percent or greater of articles (2005/2011) provided the explicit reporting of background (100%/97%), follow-up time (85%/94%), overall interpretation of data (100%/94%), and results of similar studies (95%/89%). Twenty-five percent or less of articles provided the study design in the abstract (10%/20%), a clear description of the study's setting (10%/23%), the handling of missing data (0%/6%), the potential directions of bias (5%/11%) and use of a power analysis (0%/17%). Eighty-six percent (44/51) of items were more frequently satisfied in 2011 articles compared to 2005 publications. Absolute increases in compliance rates of ≥40% were noted in 10 items (20%) with no worsening in compliance for an individual item over 6%. Discussion The overall quality of the reporting of observational trials in Journal of Hand Surgery American improved from 2005 to 2011. Current observational trials in hand surgery could still benefit from increased reporting of methodologic details including the use of power analyses, the handling of missing data, and consideration of potential bias.

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“…1,2 Risk factors for nonunion of the scaphoid include displacement after the fracture, fracture of the proximal pole, necrosis of the proximal pole fragment, and absent or delayed immobilisation. [1][2][3][4][5] Scaphoid nonunion alters wrist kinematics and can lead to dysfunction if left untreated. 6 The natural history of scaphoid nonunion is well documented, with progression to carpal collapse followed eventually by osteoarthritis (scaphoid nonunion advanced collapse (SNAC)).…”

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confidence: 99%

A comparison of the rates of union after cancellous iliac crest bone graft and Kirschner-wire fixation in the treatment of stable and unstable scaphoid nonunion

Park

Yoon

Jeon

et al. 2013

The Bone & Joint Journal

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This study was performed to determine whether pure cancellous bone graft and Kirschner (K-) wire fixation were sufficient to achieve bony union and restore alignment in scaphoid nonunion. A total of 65 patients who underwent cancellous bone graft and K-wire fixation were included in this study. The series included 61 men and four women with a mean age of 34 years (15 to 72) and mean delay to surgery of 28.7 months (3 to 240). The patients were divided into an unstable group (A) and stable group (B) depending on the pre-operative radiographs. Unstable nonunion was defined as a lateral intrascaphoid angle > 45°, or a radiolunate angle > 10°. There were 34 cases in group A and 31 cases in group B. Bony union was achieved in 30 patients (88.2%) in group A, and in 26 (83.9%) in group B (p = 0.439). Comparison of the post-operative radiographs between the two groups showed no significant differences in lateral intrascaphoid angle (p = 0.657) and scaphoid length (p = 0.670) and height (p = 0.193). The radiolunate angle was significantly different (p = 0.020) but the mean value in both groups was < 10°. Comparison of the dorsiflexion and palmar flexion of movement of the wrist and the mean Mayo wrist score at the final clinical visit in each group showed no significant difference (p = 0.190, p = 0.587 and p = 0.265, respectively). Cancellous bone graft and K-wire fixation were effective in the treatment of stable and unstable scaphoid nonunion.

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Delays and Poor Management of Scaphoid Fractures: Factors Contributing to Nonunion

Cited by 62 publications

References 19 publications

Factors Associated with Patient Delay in Scaphoid Nonunions

Factors Associated with Patient Delay in Scaphoid Nonunions

Using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement to Assess Reporting of Observational Trials in Hand Surgery

A comparison of the rates of union after cancellous iliac crest bone graft and Kirschner-wire fixation in the treatment of stable and unstable scaphoid nonunion

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