Background: Treatment of scaphoid waist fractures is generally conservative in children but surgical in adults, given the relatively high risk of non-union in adults. In adolescents, the required therapeutic strategy is less well defined. The objective of this study was to compare the radiographic and clinical parameters, and the rate of complications, between non-surgical orthopedic treatment (OT) and surgical treatment (ST) by percutaneous screw fixation of these fractures in adolescents approaching skeletal maturity.
Hypothesis: ST of non-displaced scaphoid waist fractures in adolescents allows radiographic union, a functional result and a complication rate comparable to that of ST.
Methods: This single-center retrospective study included patients who presented with a non-displaced scaphoid waist fracture, with a chronological age (CA) and a bone age (BA) between 14 and 18 years. Clinical and radiographic parameters and complications were analyzed during the trauma and at one year, including functional scores, between two groups of patients; OT and ST.
Results: Thirty-seven patients had OT (63.8%) and 21 had ST (36.2%). The median CA was 16 years [14.25-16]. The median BA was 16 years [15;17] according to the Greulich and Pyle method and corresponded to R9 [R7-R10] and U7 [U7;U8] according to the Distal Radius and Ulnar (DRU) classification system. All non-unions were found in the OT group (23.4% vs. 0%, p=0.019). The duration of immobilization (8 weeks) and the number of consultations were higher after OT than ST. Functional scores were lower in patients with non-union after OT (p≤0.002) CONCLUSION: OT of scaphoid waist fractures in adolescents results in a higher rate of non-union than ST, similar to the rate found in adults. Findings from this study recommend a surgical approach by percutaneous screw fixation.
Level Of Evidence: III; comparative retrospective study.
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Introduction: The goal of this work is to determine, using the analysis of our own patient group and current professional publications, in which cases fractures of the scaphoid waist can be treated conservatively by short-term plaster fixation with a low risk of non-union developing.
Material And Method: A group of 19 patients (17 men and 2 women) with the mean age 31 years (range 20-43, SD 7.3) with fractures of scaphoid waist were indicated for conservative treatment.
Article Synopsis
- The study investigates the effectiveness of two types of bone grafts (packed cancellous vs. corticocancellous) used in repairing scaphoid waist nonunion fractures with volar locking plates.
- Postoperative CT scans showed that 95% of patients achieved osseous bridging, but those with packed cancellous grafts had significantly better healing outcomes than those with corticocancellous grafts.
- The findings suggest that using packed cancellous autografts may lead to faster and more effective bone healing in these cases.
Scaphoid Fractures and Nonunion: A Survey-based Review of Hand Surgeon's Practice and the Evidence.
J Hand Surg Glob Online
November 2024
University of Kansas Medical Center, Department of Plastic, Burn, and Wound Surgery, Kansas City, KS.
Purpose: The Evidence-Based Practice Committee of the American Society for Surgery of the Hand set out to assess the membership's practice patterns (PPs) and familiarity with evidence-based principles for scaphoid fracture and nonunion management.
Methods: Using a consensus-generated 25-item online survey, all the American Society for Surgery of the Hand members were invited to participate via email in September 2023. Two question types were used including evidence-based practice (EBP) and PPs.
Preoperative Prediction of the Scaphoid Screw Length for the Fixation of Fractures Using MRI Measurements of Finger Phalanges.
Cureus
November 2024
Orthopedics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, GBR.
Introduction: Scaphoid fractures are one of the most common carpal bone fractures, with most fractures involving the waist. When surgery is indicated, internal fixation with screws is the standard method for the fixation of these fractures. Accurate length and trajectory of the screw are two crucial parameters essential for optimal internal fixation.
View Article and Find Full Text PDFArthroscopic Versus Open Bone Grafting and Internal Fixation of Scaphoid Nonunion-A Systematic Review.
Indian J Orthop
December 2024
Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Background: Scaphoid nonunion often requires surgical management involving the combination of a bone graft and internal fixation to restore the carpal alignment and length. While traditionally, the scaphoid waist nonunions have been treated with open bone grafts, with the advent of arthroscopy, bone graft reconstruction can now be carried out as an arthroscopic assisted minimally invasive procedure. We aimed to compare outcomes between open and arthroscopic bone grafting in the treatment of scaphoid nonunion.
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