-
outcomes:
- in the report by B. Saeden et al, the authors compared the long-term outcome in 61 patients (62 fractures)
treated operatively or conservatively for an acute fracture of the carpal scaphoid;
- total of 30 fractures was randomised to conservative treatment using a cast and 32 to operative
treatment using a Herbert bone screw;
- duration of sick leave was shorter for patients treated by operation, but this was only significant in
patients with blue-collar occupations;
- there were no differences between the groups in respect of function, radiological healing of the fracture,
or carpal arthritis after follow-up at 12 years;
- operative group showed radiological signs of arthritis of the scaphotrapezial joint more often, but this did
not correlate with subjective symptoms;
- authors recommend surgery for those patients unwilling to be immobilized for three months;
- in the report by Rettig et al, the authors followed 14 consecutive patients with acute displaced scaphoid waist fractures that
were treated with ORIF;
- technique consisted of anatomic reduction of the displaced scaphoid waist fracture, correction
of carpal instability, radial bone grafting for comminution, and internal fixation;
- patients were evaluated an average of 26 months (range, 4-48 months) after surgery;
- 13 of the 14 (93%) fractures united;
- average time to union was 11.5 weeks (range, 8-20 weeks);
- patients regained functional wrist range of motion (wrist extension, 57°; wrist flexion,
52°) and grip strength.
- in the report by L. Adolfsson et al, 53 patients with less than 14 day-old, undisplaced fractures of the
waist of the scaphoid were randomized to two groups;
- 28 patients were treated by immobilisation in a below elbow plaster cast for 10 weeks while
25 were treated by percutaneous insertion of an Acutrak standard screw;
- there were no statistically significant differences between the two treatment groups with
regard to either the rate of union or the time to union;
- patients who underwent surgery had a significantly better range of motion at 16 weeks but
there were no significant differences for grip strength;
- references:
- Fracture of the carpal scaphoid.
A prospective, randomised 12 year follow up comparing operative and conservative treatment.
B. Saedén, H. Törnkvist, S. Ponzer, M. Höglund. J Bone Joint Surg [Br] 2001;83-B:230-4.
- Open reduction and internal fixation of acute displaced scaphoid waist fractures
Michael E. Rettig, MD.
J Hand Surg 2001;26A:271-276.
- Acutrak screw fixation versus cast immobilisation for undisplaced scaphoid waist fractures.
L. Adolfsson. JHS-Br p 192-195, Volume 26B, Number 3, June 2001
Dorsal approach to scaphoid nonunion.
Corticocancellous grafting & AO/ASIF lag screw for nonunion of the scaphoid. A retrospective analysis.
Corrective osteotomy for scaphoid malunion: technique and long-term follow-up evaluation.
The Herbert screw for scaphoid fractures. A multicentre study.
A comparison of fixation screws for the scaphoid during application of cyclical bending loads.
EB Toby et al.
JBJS Vol 79-A. No 8. Aug 1997. p 1190.
