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Treatment of Displaced Scaphoid Fractures

- See:
  - Casting of Scaphoid Fractures
  - Surgery and Approach to the Scaphoid
  - Herbert Screw Fixation of Scaphoid Fractures
  - Closed Reduction of Scaphoid Fractures
  - Radiographic Imaging

- Definition: Unstable Scaphoid Fracture
- Discussion:
- one must differentiate between stable & unstable acute frx, since stable fractures have a lower incidence of complications & may be treated w/immobilization in plaster;
- any movement or displacement which is seen at frx site indicates an unstable fracture, making internal fixation treatment of choice;
- Non Operative Treatment of Unstable Frx:
- rates of non-union after non-operative treatment of unstable frxs will approach 50 %;
- even when healing does occurr,  there will also be a relatively high incidence of malposition & late collapse;
- Operative Treatment of Unstable Frx:
- primary internal fixation is treatment of choice for unstable scaphoid frxs;
- frx treated by primary internal fixation, avg time for return to work is 3.7 wks w/ union rate, 97 %;
      - this compares very  favorably with conservative treatment.
- implants include smooth K wires, cancellous bone screws;
      - consider 2.0 mm or 2.7 mm cortex screws as lag screws;
      - 3.5 mm cannulated screws as lag screws;
- Herbert screw
  - screw is threaded at both ends and can be countersunk beneath articular surface, obviating the need for removal after frx has healed;
  - it is designed to achieve compression by use of a differential thread-pitch between its proximal & distal ends, and it has guiding jig that maintains reduction & interfragmentary compression during insertion;
  - disadvantages:
         - interfragmentary compressive forces generated by Herbert screw are less than those associated with conventional screws;

- Post Op Care:
- even w/ Herbert screw fixation many recommend that immobilization be continued in short thumb-spica cast until there is evidence of frx union

Corticocancellous grafting and an AO/ASIF lag screw for nonunion of the scaphoid. A retrospective analysis.

Percutaneous pinning of symptomatic scaphoid nonunions.

Limited triscaphoid intercarpal arthrodesis for rotatory subluxation of the scaphoid.

The Herbert screw for scaphoid fractures. A multicentre study.

Treatment of ununited fractures of the scaphoid by iliac bone grafts and Kirschner-wire fixation.

Recalcitrant non-union of the scaphoid treated with a vascularized bone graft based on the ulnar artery.