Role of conservative vs operative treatment for acute scaphoid fractures (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.
Current methods of diagnosis and treatment of scaphoid fractures
International Journal of Emergency Medicine, 2011
Fractures of the scaphoid bone mainly occur in young adults and constitute 2-7% of all fractures. The specific blood supply in combination with the demanding functional requirements can easily lead to disturbed fracture healing. Displaced scaphoid fractures are seen on radiographs. The diagnostic strategy of suspected scaphoid fractures, however, is surrounded by controversy. Bone scintigraphy, magnetic resonance imaging and computed tomography have their shortcomings. Early treatment leads to a better outcome. Scaphoid fractures can be treated conservatively and operatively. Proximal scaphoid fractures and displaced scaphoid fractures have a worse outcome and might be better off with an open or closed reduction and internal fixation. The incidence of scaphoid nonunions has been reported to be between 5 and 15%. Non-unions are mostly treated operatively by restoring the anatomy to avoid degenerative wrist arthritis.
Management of clinical fractures of the scaphoid: results of an audit and literature review
European Journal of Emergency Medicine, 2005
Two to 5% of scaphoid fractures are missed on initial presentation. The failure of early recognition and treatment are considered to contribute to delayed union and non-union. Despite advances in diagnostic imaging, a dogmatic approach has persisted in the management of patients with clinical suspicion but no radiographic evidence of scaphoid fracture. A critical analysis of the current treatment protocol of indiscriminate cast immobilization and serial clinical and radiographic follow-up is presented. Methods: A prospective study involving 90 patients with clinical signs suggestive of scaphoid injury, followed up until a definite boney injury was demonstrated or the patient was discharged. A review of the literature was conducted to question the need for immobilization in these patients and the potential use of other forms of diagnostic imaging in screening for occult scaphoid fractures. Results: The incidence of true fractures of the scaphoid was 6.66% (5/75). Ten patients (13.33%) had other injuries around the wrist unrelated to the scaphoid. Eighty per cent of the patients had no definite boney injury and were needlessly immobilized, and followed up. A total of 128 scaphoid casts, 135 sets of scaphoid X-rays, 135 clinic appointments and a cumulative 148 weeks of cast immobilization involved patients with normal wrists. Conclusion: The incidence of radiologically inapparent fractures of the scaphoid is low. The use of a tender anatomical snuff box as the only clinical sign in the diagnosis of scaphoid injury is unsatisfactory. Other injuries around the wrist must be carefully excluded. There is insufficient evidence to support immobilizing all patients with clinical scaphoid fractures. For suspected fractures with no radiological evidence, symptomatic treatment is probably sufficient. Most occult fractures are visible at 2 weeks. Both magnetic resonance imaging and bone scintigraphy are accurate and cost effective and should be performed earlier rather than later.
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...
Review of treatment of acute scaphoid fractures: R1
ANZ Journal of Surgery, 2012
Scaphoid fractures are common. Clinical suspicion and early diagnosis and treatment are vital in order to avoid complications such as avascular necrosis. The management of these fractures depends on fracture characteristics, specifically the degree of displacement. With consideration of patient factors, such as occupation, the treatment can be non-operative or operative. There has been much debate in the recent literature regarding the best management of these fractures. The purpose of this review was to identify the current evidence for non-operative and operative treatment. Undisplaced and minimally displaced fractures can be managed non-operatively with a scaphoid cast. Surgical treatment is used for fractures with displacement of >1 mm.
Comparison of management of undisplaced scaphoid fractures: Conservative methods versus
2018
Introduction: Fractures of the scaphoid bone account for approxim ately 10% of the hand fractures. Traditionally, non displaced fractures of the scaph oid have been treated conservatively with immobilization of hand with cas t. Now surgical increasing. The aim of this study is to evaluate op rative versus non operative treatments for acute undisplaced or minimally displaced scaphoid fractur es. randomized prospective clinical study was conducted on 15 patients with fracture scaphoid treated with conservative techniques and ORIF by tr ained surgeons at a tertiary tr centre in the Department of Orthopedics, B between May 2016 and May 2017. Fracture patterns w ere classified on basis of Herbert classification. Observation and results mechanism of injury as axial load on hyperextended an radially deviated wrist. Average period for immobilization for conservative was 10we eks and after surgery was 2 weeks. 11.11% patient managed conservatively had undergone surgery had undergone nonu ion...
Treatment of Acute Scaphoid Fractures
Clinical Orthopaedics & Related Research, 2007
The authors concluded that operative treatment of acute nondisplaced or minimally displaced scaphoid waist fractures is associated with an increased risk of complications and possibly an increased risk of scaphotrapezial joint osteoarthritis compared with non-operative treatment, but there were no between-treatment differences for other outcomes. This was generally a well-conducted review and the authors' conclusions are likely to be reliable. Authors' objectives To compare operative and non-operative treatments and different types of casting methods for acute scaphoid fractures. Searching PubMed and the Cochrane Controlled Trials Register were searched. Some details of the search strategy were reported. The references of relevant studies were also handsearched. Studies were only included if they were published as full reports in English. Study selection Study designs of evaluations included in the review Randomised controlled trials (RCTs) and quasi-RCTs were eligible for inclusion in the review. The duration of followup ranged from 6 months to 11.7 years in the included studies.
Fractures of the scaphoid, diagnosis and managementa review
Acta chirurgica iugoslavica, 2013
The scaphoid is vitally important for the proper mechanics of wrist function. Fracture of the scaphoid bone is the most common carpal fracture. Among all wrist injuries the incidence of scaphoid fracture is second only to fractures of the distal radius. Scaphoid fractures are significant because a delay in diagnosis can lead to a variety of adverse outcomes that include nonunion, delayed union, decreased grips strength, range of motion and osteoarthritis of the radiocarpal joint. To avoid missing this diagnosis, a high index of suspicion and a through history and physical examination are necessary, because initial radiographs are often negative. Regardless of the technique of bone grafting, there will almost always be some loss of motion even if the fracture unites.
International Journal of Medical and Biomedical Studies
Aim: to compare the results of operative fixation of acute scaphoid fractures with those of non-operative treatment. Materials & Method: This clinical study was carried out among 26 patients with an acute nondisplaced or minimally displaced scaphoid fracture reported to the OPD of Orthopedics, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India. Patients were non-randomly allocated to group A (non-operative treatment with a cast) and group B (internal fixation with a Herbert screw). Results: mean age of the study population was 41.23 years. Majority of them were male 21 (80.7%) and rest 5 (19.3%) were female. Out of total 26 scaphoid fracture cases 16 (61.5%) were of right hand and rest 10 (38.5%) found on the left hand. Most common location of fracture was waist fracture (B2) 10 cases. 100% union was observed in group B. Conclusions: study proves that Cast treatment has the disadvantages of longer immobilisation time, joint stiffness, reduced grip strength, and l...
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.