Scaphoid Plate Osteosynthesis in Complex Fractures and Wrist Trauma: A Case Series

Abstract

Introduction Treatment of scaphoid fracture is challenging due to its unique blood supply and geometry. Traditionally, a headless compression screw is the standard treatment for unstable scaphoid fracture. Some fractures are complex, for example, comminution with bone loss. A scaphoid plate is an option in these difficult fractures providing adequate rotational stability. Aim To share our experience in using scaphoid plates in complex wrist trauma and comminuted fractures. Method and material Complex wrist trauma involving scaphoid fractures that were comminuted and multi-fragmentary fractures treated with plate osteosynthesis were retrospectively reviewed between July 2019 and September 2021. Patient demographic data, preoperative radiographs, CT scans, pain, wrist range of motion, and fracture union rate to union were reviewed. Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH®) score was recorded at 1-year postoperative follow-up. Results Nine patients associated with complex wrist trauma were included in this case series. The mean follow-up was 2.5 years (13-30 months). The union rate was 100%. The mean arc of motion was 105° (95-110°). QuickDASH® score was 19.96 at 1-year postoperative follow-up. Four patients had good outcomes, four satisfactory, and one poor outcome. One hardware complication was observed which was the impingement of the plate proximally over the articular surface of the distal radius. Conclusion A scaphoid plate is a reliable option for treating complex and difficult fractures. It provides adequate stability, especially in comminution, bone loss, or multi-fragmentary fractures which are not amendable using other fixation methods. We recommend the expansion of plate osteosynthesis beyond scaphoid nonunion into complex wrist trauma.

In vivo non-contact regions of proximal scaphoid in six extreme wrist positions

“…For this specific healing mode of the scaphoid, rigid internal fixation with compression to eliminate the intra-fragmental gap and mobilization would seemly be mandatory [ 3 , 4 ]. Screw plays a major role in the implant for the broken scaphoid, while there is technically demanding much difficult in plates [ 5 , 6 ]. Dodds et al demonstrated the longest possible screw placed centrally and deep in both the proximal and distal scaphoid poles would have biomechanical superiority in for the fracture fixation stabity [ 7 ].…”