Getting it right first time: a management protocol for acute and subacute fractures of the scaphoid (original) (raw)
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Percutaneous treatment for waist and proximal pole scaphoid fractures
Revista Brasileira de Ortopedia (English Edition), 2018
Objective: Analyze the percutaneous fixation technique for scaphoid fractures in the waist of the scaphoid and the proximal pole, and demonstrate its result. Methods: A retrospective cross-cohort study conducted from January 2005 to April 2015, aiming at the consolidation time, epidemiological profile, level of function, return to work, and complications. Results: Twenty-eight patients were selected, with a mean of eight weeks of follow-up. They presented a mean age of 30.5 years, male prevalence (25 patients; 89.2%), and no differences between dominant and non-dominant sides. The mean time from diagnosis was 4.16 weeks, but in three cases of fibrous union, the pre-operative period was over one year. The most frequent mechanism of injury was a fall on the outstretched hand, in 22 cases (78.5%). Of all fractures, 24 cases were in the waist (85.8%) and four were of the proximal pole (14.2%); seven patients had displacement (25%). There was consolidation in 26 cases (92.8%) with a mean of 7.5 weeks after surgery. In cases of non-union, radiological follow-up was up to 24 weeks, requiring a new surgical intervention. Conclusions: Percutaneous fixation is an excellent, reproducible technique that allows early active mobility of the wrist with a low complication rate, although it requires a learning curve.
Delays and Poor Management of Scaphoid Fractures: Factors Contributing to Nonunion
The Journal of Hand Surgery, 2011
Purpose Scaphoid fracture nonunion remains prevalent, and it was our purpose to examine the initial care, fracture site, and patient gender and age to determine factors contributing to fracture nonunion. Methods The charts of 96 consecutive patients with 99 scaphoid fracture nonunions were reviewed for demographic information, and contact was made with 85 patients (with 88 scaphoid nonunions) to determine the pattern of presentation and initial treatment, if any. Results Of the 88 scaphoid nonunions, 78 were in men, and 46 were sports injuries; 7 patients had no recollection of an injury. Twenty were proximal pole fractures. For 57 fractures, patients sought care following their injury, but only 42 were diagnosed with scaphoid fractures and received appropriate treatment, although one did not follow up in the clinic. Fifteen patients with nonunions did not receive radiographic investigations or did not have an identifiable fracture on initial x-rays and received no further follow-up or treatment. For 27 nonunions, medical attention was sought but was delayed, with an average time of 57 days between injury and initial assessment. For 31 fractures, medical attention was not sought for the acute injury but presented later following a re-injury (17 nonunions) or with progressive pain or stiffness (13 nonunions). Conclusions The high rates of delayed presentation and incomplete evaluation and treatment suggest a strong need for better patient and doctor education on the subject of scaphoid injuries and nonunions particularly because the initial injury is, unfortunately, sometimes perceived as trivial. Nonunions do occur despite appropriate immobilization. Proximal pole fractures and fractures that show inadequate progression toward union while being treated in a cast should be considered for surgical intervention based on the high number of such cases identified in this studyType of study/level of evidence Prognostic II.
The Journal of Hand Surgery, 2007
Purpose: To evaluate the clinical and radiographic outcomes of a consecutive series of patients who had internal fixation of an acute, nondisplaced scaphoid waist fracture via a limited dorsal approach. Methods: Twenty consecutive patients had surgical fixation of a nondisplaced scaphoid waist (Herbert B2) fracture via a limited dorsal approach. Eighteen patients were available for follow-up evaluation at a mean duration of 98 weeks after surgery (range, 12-272 wk). Fifteen males and 3 females with a mean age of 25 years (range, 16 -62 y) were examined. Wrist range of motion; grip strength; visual analog and numeric pain scores; and a Disabilities of the Arm, Shoulder, and Hand (DASH) outcomes questionnaire were assessed. Postoperative radiographs were reviewed in a blinded fashion to assess the fracture union and screw position. Results: Seventeen of 18 fractures healed at a mean duration of 8 weeks. No case of proximal pole avascular necrosis occurred. All patients were satisfied and returned to their pre-injury level of employment. Five of 6 collegiate or professional athletes returned to play without limitations. The mean subjective and visual analog pain scores were 0.3 and 0.4 (maximum of 10 for each scale). The mean DASH score was 6.12 (out of 100), which is consistent with an excellent functional outcome. Central axis screw position was achieved on anteroposterior and lateral radiographs in 17 of 18 patients. Conclusions: Fixation of an acute, nondisplaced scaphoid waist fracture via a limited dorsal approach is safe and effective. The limited dorsal approach allows for accurate insertion of the screw in the central scaphoid, which is biomechanically advantageous for fracture union and early restoration of function. (J Hand Surg 2007;32A:326.e1-326.e9.
Diagnosis and Treatment of Scaphoid Waist Fractures: A Literature Review
Journal of Orthopedic and Spine Trauma, 2020
Scaphoid fracture can cause serious complications and its diagnosis and treatment approaches are still contentious. Tenderness of anatomical snuffbox (ASB), longitudinal compression (LC) of the thumb, and scaphoid tubercle (ST) tenderness are very sensitive tests for clinical diagnosis of scaphoid factures all together. Previous studies recommend taking four standard views of the wrist for non-displaced scaphoid fractures diagnosis. Magnetic resonance imaging (MRI), computed tomography scan (CT scan), bone scintigraphy, and ultrasound are used for triage of suspected scaphoid fractures. MRI has the highest sensitivity and specificity. CT scan images captured in planes by the long axis of the scaphoid guide the diagnosis of nondisplaced scaphoid fracture. Displaced fractures need surgical treatment, but the best way of treating a nondisplaced fracture is controversial. Same results have been determined using a short arm or long arm cast for treatment of nondisplaced scaphoid fracture...
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.
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.
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...
Acute Fractures of the Carpal Scaphoid-Literature Review
MOJ Orthopedics & Rheumatology, 2016
Introduction/Methods: Scaphoid fractures are the most common fractures of the carpal bones of the wrist, and represent 11% of all fractures of the upper extremity and between 70% and 80% of all carpal fractures. In most cases, the mechanism of injury is a fall with the wrist extended. Although conservative treatment of stable fractures of the carpal scaphoid associated with a high rate of consolidation, this method requires prolonged immobilization in a cast or brace, which generates muscular atrophy, possible muscle spasms, osteopenia disuse, as well as higher economic costs. Therefore, the internal fixation of fractures of the scaphoid has become popular. The aim of this study is to establish the current evidence supporting surgical treatment versus conservative in acute fractures of the carpal scaphoid, through a literature review of the literature. In addition consider whether treatment recommendations population can be extrapolated to amateur athletes and / or professionals. Results: Our search found 69 articles that met the inclusion criteria, 10 articles were considered belonging to the group level of evidence 1 Oxford Center for Evidence-based Medicine, 2 items to the group of evidence 2 and 57 items to groups evidence 3 and 4. Conclusion: Currently there is insufficient evidence about the indications and effectiveness of conservative versus surgical treatment of acute fractures carpal scaphoid. There are no controlled clinical studies in only athlete population, so they cannot be made treatment recommendations based on the evidence in this subpopulation. of fractures of the proximal pole of the scaphoid and delays of Volume 5 Issue 5-2016
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.