Patterns of union in fractures of the waist of the scaphoid

Abstract

Eighty-two of 85 patients who had sustained a fracture of the waist of the scaphoid in 1985 were reviewed more than one year after injury. The incidence of nonunion, defined as a clear gap at the fracture site one year after injury, was 12.3%. This was much higher than expected. Most of the patients with nonunion had symptoms and had appreciable restriction of wrist movement. In a further 25% of the patients at review, the site of the fracture could be easily identified although it appeared to have healed. These patients were older and more of them were women. Three-quarters of these patients had symptoms but their wrist movement was essentially normal.

Surgical Compared with Conservative Treatment for Acute Nondisplaced or Minimally Displaced Scaphoid Fractures

“…Traditional arguments in favor of surgical treatment for acute scaphoid fractures include (1) incomplete healing or nonunion in association with conservative treatment 35,42 , (2) reduced range of motion following cast immobilization 35,43 , (3) muscle weakness and reduced grip strength 35,43 after prolonged immobilization, and (4) osteoarthritis at the time of long-term follow-up 43 . In addition, the socioeconomic argument of delay in return to work or sports is becoming more important in current algorithms to decide between conservative and surgical treatment of suspected scaphoid fractures as well as other fractures.…”

Scaphoid fracture nonunion: correlation of radiographic imaging, proximal fragment histologic viability evaluation, and estimation of viability at surgery

“…Although the majority of scaphoid fractures heal without surgery, most case series report an approximate 10 % non-union rate [2]. Any fracture that persists for longer than six months is considered a nonunion [3].…”

Bone grafting the scaphoid nonunionA systematic review of 147 publications including 5 246 cases of scaphoid nonunion

“…The diagnosis may be missed by the patient not seeking medical examination and by the physician diagnosing a sprained wrist. Nonunion occurs in approximately 5% (0-22) (Stewart 1954, Eddeland et al 1975, Morgan and Walters 1984, Dias et al 1989, Larsen et al 1992, Duppe et al 1994, Barton 1997, Khan and Harby 1995, Raudasoja et al 1999, Roolker et al 1999). …”