Acute Fractures of the Carpal Scaphoid-Literature Review (original) (raw)
Related papers
The management of scaphoid fractures
Journal of Science and Medicine in Sport, 2005
Appropriate management of scaphoid fractures is important because of the risk of longterm complications such as delayed or non-union, pain and disability. Up to 25% of scaphoid fractures are not visible on the initial radiographs. Consequently, all clinically suspected scaphoid fractures are treated as fractures with cast immobilisation until cause of the symptoms is clarified. The diagnosis often utilises a number of second line investigations that are generally performed 10-14 days after the injury. Bone scintigraphy is currently the most commonly used of these as it rarely misses a fracture. However. it does not visualise anatomical structure and therefore alternative diagnoses are difficult. Magnetic resonance imaging (MRI) is at least as sensitive and more specific than bone scanning and has the advantages of being able to identify other lesions and not expose the patient to any radiation. Furthermore. the scan may be performed as early as 2.8 days following an injury rather than 10 days later in the case of a bone scan. Although the cost of MRI is higher than other imaging modalities, it may be costeffective in the overall management of patients with occult scaphoid fractures since it may prevent unnecessary cast immobilisation in active people. The most appropriate method of cast immobilisation is presently unclear but evidence exists for improved clinical outcomes in those that have both the thumb and elbow immobilised for the first six weeks. (J Sci Med Sport 2005;8:2:181-189) The importance of scaphoid fractures Wrist injuries are common, ranging from simple sprains to more severe fractures and dislocations. Literature has indicated that 3%-9% of all athletic injuries involve the hand or wrist 1. Most of these heal uneventfully, even with delayed treatment, but some injuries result in long-term disability and pain if not diagnosed quickly and treated correctly.
Conservative treatment of scaphoid fracture: Protocol for a systematic review
Research, Society and Development
The scaphoid is the most commonly fractured carpal bone. Fractures affecting this bone affect young and active patients between 15 and 40 years of age. Stable scaphoid fractures are treated conservatively by plaster cast immobilization or other type of orthosis for an average period of four to 12 weeks. Failure to treat scaphoid fractures may result in avascular necrosis, nonunion, and early secondary osteoarthritis, which may result in significant economic and social impact due to the affected population, formed by young people of productive age. The management of this type of fracture varies significantly between different Institutions and orthopedic surgeons. This article describes a protocol for a systematic review that aims to evaluate the effects (benefits and harms) of conservative interventions in the treatment of scaphoid fractures in adults.
Management of late-diagnosed scaphoid fractures
2010
The scaphoid is the most frequently fractured carpal bone. Despite recent advances in the understanding of scaphoid fractures, a number of questions remain unanswered. Diagnosis of scaphoid fracture can be complicated, and this type of fracture can be easily overlooked in an acute injury. 6 Unfortunately, owing to its unique anatomical structure, neglected scaphoid fractures seldom heal with acceptable alignment; this often leads to complications in their management. 2,8,10,11 In cases of non-union or malunion, reconstruction of the scaphoid is exceedingly difficult, and this increases the chances of morbidity already associated with an extended period of hand immobilisation. 9,12,14 Despite the many reports on their management, scaphoid fractures are managed largely on the basis of anecdotal evidence and traditional remedies. Few reports refer to the management of neglected scaphoid fractures in the subacute stage; these fractures theoretically require prompt but meticulous treatment to prevent chronic sequelae. The purpose of this report is to elucidate the essential elements in the diagnosis and management of scaphoid fractures detected in the subacute stage.
The fractured carpal scaphoid. Natural history and factors influencing outcome
The Journal of Bone and Joint Surgery. British volume, 1981
The scaphoid fracture is commonest in young men in the age group 15 to 29 years, who have the highest incidence of non-union, take the longest time to unite, lose more time from work, and spend the longest time as outpatients. A union rate of 95 per cent can be achieved using standard simple treatment. All but a few fractures are visible on the first radiograph, and failure of visualisation at this stage is not associated with a bad outcome. The postero-anterior and semipronated views are the most important to scrutinise. Crank-handle injuries have a particularly bad prognosis when they produce a transverse fracture of the waist of the scaphoid. Poor prognostic factors are displacement during treatment, the fracture line becoming increasingly more obvious, and the presence of early cystic change. The severity of trauma is an important factor to elicit from the history.
Role of conservative vs operative treatment for acute scaphoid fractures
IP innovative publication pvt. ltd, 2019
Scaphoid fracture is a difficult fracture to deal with. This tiny twisted bone, 80% covered with joint cartilage and lying angulated by 45° in both planes deep in the wrist, has caused great frustrations among wrist surgeons. Diagnosis is difficult, classification is controversial & there is never ending debate on appropriate treatment protocol. Firstly, scaphoid fracture is prone to be missed in clinical assessment & is usually neglected as simple wrist injuries. Adding to that, this notorious fracture is often missed in first x-ray immediately after injury. Second line of investigation is a matter of debate & varies from doctor to doctor & centre to centre. This does not end here. Once diagnosed, there is no clear-cut protocol for deciding appropriate treatment technique. There is controversy regarding whether to be managed conservatively or operatively. Both have their own pros & cons. If managed conservatively, there is again no agreement in the literature as to the optimum position of immobilization (extension, ulnar deviation, neutral) or type of cast (thumb-spica, interphalangeal [IP] free/IP included, long arm/short arm). Last but the most nuisant are the complications. Scaphoid fracture is known for its complications like AVN, Non-union, arthritis owing to its peculiar blood supply, position in wrist & shape. Management of these complications are again not free of confusions & controversies. In this study we have tried our best to address these dilemmas & study this notorious bone in further detail.
IFSSH ezine, 2011
Scaphoid fractures generally progress to a certain type of carpal instability, i.e. DISI, if the fracture was not appropriately treated and turned to nonunion. Usually such instability produces incongruity between carpal bones followed by synovitis, becomes painful within a few years, and often requires surgical treatment in due course. However, it is also true that some types of scaphoid fractures are less symptomatic and often left untreated. Long after fracture around more than ten years, fracture nonunion becomes symptomatic and radiographic examination reveals massive osteophytes formation around the scaphoid. Moreover, despite the long duration after injury, we often encounter cases without severe DISI deformity. Recent 3-dimenssional analysis of scaphoid nonunion has revealed that carpal instability following scaphoid nonunion is closely related to whether the fracture line passes distal or proximal to the scaphoid apex. The scaphoid apex, which is the most dorsal and ulnar nonarticulating part of the scaphoid1, where the dorsal scapholunate interosseous ligament and the proximal fi ber of the dorsal intercarpal ligament attach. In their article, there were two clear patterns of the interfragmentary motions of the scaphoid based on the fracture location. In the unstable (mobile) type scaphoid nonunion, the fracture was located distal to the scaphoid apex, and the distal scaphoid was unstable relative to the proximal scaphoid. In the stable type scaphoid nonunion, the fracture was located proximal to the scaphoid apex, and the interfragmentary motion was considerably less than with the distal type. Through several researches investigating scaphoid nonunions 3-dimensionally 1, 3-5, I have noticed that for ordinary clinician, judgments of fracture locations using 2-dimensional and conventional x-rays were often inaccurate when compared to judgments using 3-dimensional CT images. For example, fi gure 1 shows two pulse: committee reports Figure 1: Oblique view X-ray and 3-D images of two patients with A) type 1 B1 and B) B2 scaphoid nonunion. Despite relationships between fracture line and the scaphoid apex are completely diff erent, fracture lines on teh scaphoid body on the x-ray look similar.
Pakistan Journal of Medical and Health Sciences
Aim: The goal of this study was to assess the efficacy of conservative versus surgical treatment for acute scaphoid fracture. Study design: A longitudinal study Place and Duration: This study was conducted at Fauji Foundation Hospital, Rawalpindi, MMC college Mirpurkhas, BMCH Quetta, PHQ hospital Gilgit Pakistan from June 2020 to June 2021. Methodology: A total of 60 acute scaphoid fractures (within three weeks) were included in this study, regardless of location. During the clinical examinations, diagnostic tests were done. Patients were urged to have wrist radiography check if any of these tests were positive. If radiography revealed no fracture, the wrist was immobilised with a below-elbow slab, and the patient was instructed to return in 15 days. After two weeks, the identical x-ray series was repeated Results: During the study period, 60 cases of acute scaphoid fracture (< 3 weeks) were seen. The average age of patients was 36.5 years. There were n=48 (80%) male patients and...