Percutaneous Screw Fixation Without Bone Graft for Cystic-Type Scaphoid Fractures

Abstract

designing a treatment strategy, so we expanded this classification system to acute scaphoid fractures (Fig. 1). The purpose of this study is to explain our treatment strategy based to our new classification system for scaphoid fractures and to demonstrate that bone graft is not necessary for cystic type fractures. PATIENTS AND METHODSWe retrospectively studied the 105 scaphoid fractures (Table 1) of 94 male and 11 female patients ranging in age from 14 to 67 years (average, 26 years). The radiograms were taken of the following views: posteroanterior, lateral wrist, scaphoid (posteroanterior in ulnar deviation), and oblique with 45 degrees to 60 degrees of pronation 5 . Bone union was estimated from all 4 views. There were 12 proximal pole fractures and 93 waist fractures. We omitted tubercle fractures from this study and defined acute fractures as injury happened less than 2 months before surgery, and delayed fractures as more than 2 months. There were 48 acute fractures and 57 delayed fractures. The reason why we had more delayed fractures than acute fractures was that the delayed fracture patients were referred to us in our area. We classified the scaphoid

Rotational Stability of Scaphoid Osteosyntheses: An In Vitro Comparison of Small Fragment Cannulated Screws to Novel Bone Screw Sets

“…Particularly for our inquiry, this can only be compared to clinically found fractures to a limited extent, since it does not offer interlocking fragments, which can result in a certain blocking effect against rotation even in simple compression screw treatment. By using a linear osteotomy in cadaver scaphoids on the other hand, we did not evaluate the effect of comminution, oblique fractures, not completely reduced fractures, cystic type fractures [ 28 ], interpositional bonegrafting [ 24 ] or cartilage interposition which may decrease the general stability of the fracture in the in vivo situation.…”

Screw Fixation Alone for Scaphoid Fracture Nonunion

“…7,8,15,24,25 Many techniques have been described, but the optimal treatment of scaphoid nonunion continues to be debated. 4,7,13,24,26,27 Union rates for this technique have been reported as high as 100%. Authors recommend grafting to compensate for bone loss, correct scaphoid deformity, restore normal wrist kinematics, facilitate screw placement, and induce osteogenic signaling.…”

“…6,14 Several authors have suggested that stable, well-aligned and vascular nonunions require only rigid fixation to achieve union. 13,14,26 In much the same way that cannulated headless compression screws have expanded surgical indications to include even nondisplaced acute scaphoid fractures by simplifying the procedure and making it less invasive, several authors 2e6 have found that this minimally invasive approach may also translate into certain established scaphoid fracture nonunions.…”

Scaphoid Fracture - Overview and Conservative Treatment

“…7) We reported Ikeda's classification (Fig. 2), 8) which did not consider the time interval between injury and treatment, was based on radiographic findings and proposed a specific treatment strategy.…”

“…7) We reported Ikeda's classification (Fig. 2), 8) which did not consider the time interval between injury and treatment, was based on radiographic findings and proposed a specific treatment strategy.Scaphoid fractures have a tendency for nonunion due to the nature of intraarticular fracture and vulnerable vascularity of the proximal fragments. 9) Moreover, the clinical problem is that some patients do not seek medical assistance at the time of injury and some fractures are not recognized on initial radiographs.…”