- outcomes:
- in the report by Saeden B, 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 Adolfsson L, 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.
- Open reduction and internal fixation of acute displaced scaphoid waist fractures
- Acutrak screw fixation versus cast immobilisation for undisplaced scaphoid waist fractures.
Dorsal approach to scaphoid nonunion.
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.