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Surgical Treatment of Scaphoid Frx: Outcomes

    - 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.

Corticocancellous grafting and an 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.