Percutaneous Treatment of Unstable Scaphoid Waist Fractures

Abstract

Manual closed reduction followed by percutaneous headless, compression screw fixation was possible in 50% of patients who presented with acute unstable, displaced scaphoid fractures. This technique appears to be a safe and effective method when a manual reduction is possible, and it may offer a less invasive option when compared with a standard open technique.

Percutaneous fixation of acute scaphoid waist fractures: Long-term patient-reported functional outcomes and satisfaction at a mean of 11 years following surgery

“…The total complication rate of 11% in this study is not trivial, but it is important to note that this is comparable with previous studies investigating percutaneous fixation [18][19][20][21]36], and cast immobilisation [17,37]. Non-union occurred in 5% of cases, and these patients reported the worst functional outcomes, although satisfaction was high.…”

“…Previous authors have reported promising functional outcomes in the short and medium term [18][19][20][21] but few studies report longer term follow up utilising PROMs for this treatment strategy [14,33]. The functional outcomes reported in our study are comparable with the longterm functional outcomes of conservative treatment [14,15] and percutaneous fixation [14], as well as the normative values of PROMs reported by a healthy population without pathology affecting the hand or wrist [34,35].…”

“…Furthermore, our patient electronic records for the region and national radiographic archive were both consulted to identify any further complications, and attempts were made to contact the family physician of each of these patients, but the vast majority had moved to a different geographical location and had deregistered from their physician. Despite the attritional loss to follow up rate, this study is strengthened by the large number of patients within the cohort and long term follow up, which compares favourably with previously published studies investigating outcomes after percutaneous fixation [18][19][20][21].…”

“…However, there are very few studies that describe the long-term PROMs following acute percutaneous fixation of non-displaced or minimally-displaced fractures. These studies are usually limited by heterogenous fixation techniques [14,15,17], small patient cohorts [18][19][20] or short follow-up periods [18][19][20][21]. Disabling complications relating to non-union and posttraumatic arthrosis may not appear for many years following a scaphoid fracture [22], and it is evident that studies reporting early and mid-term follow-up following percutaneous fixation may underestimate these complications.…”

The “Standing Peanut” Scaphoid View: A Semi-supinated Radiographic View for Intraoperative Evaluation of Screw Placement in Scaphoid Waist Fractures

“…3,12 Intraoperative fluoroscopy traditionally utilizes multiple fluoroscopic views for proper central placement of the cannulated screw. 8,10,13 The unique shape of the Sc and its articulations with other members of the carpus make it difficult to isolate its entire body and visualize its proximal articular surface. 14 Without proper visualization of the entire Sc and its articular surfaces, proximal screw penetration can go undetected and increase the risk for scapholunate or radioscaphoid arthritis, even if acceptable central axis screw placement is achieved.…”