Should Acute Scaphoid Fractures Be Fixed?

Dias, JJ; Wildin, C.; Bhowal, B.; Thompson, John R.

doi:10.2106/00004623-200510000-00002

Cited by 22 publications

(70 citation statements)

References 11 publications

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“…Complications described above werer elated as delayed healing or nonunions. The other reported complications described in open repair were not observed including hypertrophic scar,A Vn ,carpal instability, donor site pain, bone graft infection, screw protrusion and reflex sympathetic dystrophy (RSD) (12,13). These complications werea voided using minimally invasive surgical techniques including arthroscopy and mini-fluoroscopy.These techniques reduced additional soft tissue injury and permitted the early restoration of hand function.…”

Section: Discussionmentioning

confidence: 99%

“…Ahigh union rate has been reported with immediate open repair of acute scaphoid fracturet reated with headless compression screw (7,8,9,10,11). However, significant complications have been reported using an open volar approach and rigid fixation with aHerbert screw (12,13). While the cast treatment of unstable scaphoid fractures results in an onunion rate as high as 50% (14), even stable fractures cannot be reliably treated by plaster immobilization with nonunions as high as 22% (13).…”

Section: Introductionmentioning

confidence: 99%

“…However, significant complications have been reported using an open volar approach and rigid fixation with aHerbert screw (12,13). While the cast treatment of unstable scaphoid fractures results in an onunion rate as high as 50% (14), even stable fractures cannot be reliably treated by plaster immobilization with nonunions as high as 22% (13). The treatment of scaphoid nonunions is ac hallenge even for the most skilled hand surgeon with a22-50% failurerate reported for the open surgical repair of scaphoid nonunions with bone graft (15,16,17,18).…”

Section: Introductionmentioning

confidence: 99%

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Retrospective Review of 234 Scaphoid Fractures and Nonunions Treated with Arthroscopy for Union and Complications

Slade

Gillon

2008

Scand J Surg

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the purpose of this paper is to retrospectively review 234 consecutive cases of scaphoid fractures and nonunions treated using arthroscopy with the dorsal percutaneous implantation of ah eadless compression screw for healing and complications. solid union of fracture is determined by ct scan. we identified 126 acute injuries, including 65 proximal pole fractures; 67 grossly displaced fractures; 12 trans-scaphoid perilunate dislocations including four trans-scaphoid trans-capitate fractures; and ten combined scaphoid and distal radius fractures. 108 scaphoid nonunions were identified. 98 were correctly aligned and ten had ah umpback deformity which was correctable using arthroscopic assisted reduction techniques at the time of surgery.8 2p resented with af racture gap 2mm or greater requiring percutaneous bone grafting. 12 cases of avascular necrosis (avn) were identified by mRi. 20 nonunions had surgery performed at other institutions. the mean time to surgery for the nonunions was 20 months.99% union rate of acute scaphoid fractures was obtained by 12 weeks, as determined by ct scan. twoc omplications were identified (3%). one case of delayed healing was identified. this delayed union was treated with percutaneous bone grafting and continued on to heal uneventfully.the other complication was acase of volar trans-scaphoid peri-lunate dislocation. while the fracture healed, the patient developed at raumatic dislocation requiring ac apitate-lunate arthrodesis. tr eatment of scaphoid nonunions resulted in ten cases of delayed healing, which were treated with repeat percutaneous bone grafting. this represented a9 %c omplication rate. of the ten cases of delayed unions that were re-bone grafted, four failed to heal by nine months. this resulted in a 96% union rate of our nonunion group by nine months. when acute fracture healing was compared to nonunions the average healing of acute fractures as determined by ct scanning measuring trabecular bridging was 12 weeks, while the average healing of nonunions was 22 weeks. we conclude that the dorsal percutaneous treatment of scaphoid fractures and nonunions using arthroscopy is safe and effective. ct scans to evaluate scaphoid healing by measuring trabecular bridging at the fracture site was determined to be an excellent modality to evaluate scaphoid healing. while not witnessed in this series, the potential for complications requires proper training.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Retrospective Review of 234 Scaphoid Fractures and Nonunions Treated with Arthroscopy for Union and Complications

Slade

Gillon

2008

Scand J Surg

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“…Pain was measured on a scale from 0 to 4. For 0 is best and 4 is worst 13 14. Patient satisfaction was measured on a five-point scale 15…”

Section: Methodsmentioning

confidence: 99%

“…If means and CIs were reported instead, SDs were calculated from these values. If required data could not be obtained from published data, in seven13 14 18 20–23 of the 1013–18 20–23 selected studies we referred to unpublished data obtained from the authors. Incomplete data (eg, means without SDs) could not be used and was excluded from this meta-analysis.…”

Section: Methodsmentioning

confidence: 99%

Surgical treatment of non- and minimally-displaced acute scaphoid fractures favours over-conservative treatment but only in the short term: an updated meta-analysis

et al. 2016

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Treatment of Acute Scaphoid Fractures: A Systematic Review and Meta-Analysis

Suh¹,

Benson

Faber³

et al. 2010

Hand (New York, N,Y.)

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Background/Methods The purpose of this review was to assess the current evidence supporting operative fixation versus casting for acute scaphoid fractures through a systematic review and meta-analysis of the literature. Results Our search yielded 59 articles that met our inclusion criteria with five studies achieving high, 22 moderate, and 32 low Structured Effectiveness Quality Evaluation Scale scores. Pooled results of the four Sackett level 1 evidence studies showed no significant difference between the operative (114/115, 99%) versus non-operative group (106/112, 95%) (p=0.07) when the definition of nonunion was based on more definitive criterion versus plain radiographs that may be insufficient to assess bony union. Similar results were found for the Sackett level 2 and 4 articles.Conclusions This systematic review reveals that significant weaknesses exist in the literature with respect to the level of evidence and quality of published studies on this topic. Currently, there is insufficient evidence to support the most effective treatment for acute scaphoid fractures.

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Should Acute Scaphoid Fractures Be Fixed?

Cited by 22 publications

References 11 publications

Retrospective Review of 234 Scaphoid Fractures and Nonunions Treated with Arthroscopy for Union and Complications

Retrospective Review of 234 Scaphoid Fractures and Nonunions Treated with Arthroscopy for Union and Complications

Surgical treatment of non- and minimally-displaced acute scaphoid fractures favours over-conservative treatment but only in the short term: an updated meta-analysis

Treatment of Acute Scaphoid Fractures: A Systematic Review and Meta-Analysis

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