Combined Fractures of the Scaphoid and Distal Radius: Evaluation of Early Surgical Fixation (21 Patients with 22 Wrists)

Abstract

The purpose of this retrospective study, is to evaluate the clinical and functional results of early surgical fixation of the ipsilateral distal radius and scaphoid fractures in 22 of 21 patients. Overall, 22 combined ipsilateral scaphoid, and distal radius fracture treatments between 2002 and 2015 were evaluated. The mean age was 34.9 (range: 19-82) years. One patient had bilateral injuries. In 17 patients the injury was due to a fall from a height, and in 4 patients due to a motorcycle accident. According to the AO classification, there were 2 type B and 20 type C fractures of the distal radius. The volar locking plate fixation technique was applied in 14 wrists, screw fixation technique in 1, external fixation combined with Kirschner wires (K-wire) stabilization technique was used in 3 wrists, and only K-wire pinning technique was used in 4 wrists. All scaphoid fractures were type B (21 type B2, 1 type B1) according to the Herbert-Fischer classification. K-wire fixation was applied in 2 and cannulated screw fixation was performed in 20 fractures. Clinical evaluation was performed with measuring the pinch power, grip power, and range of motions. Functional evaluation was performed using patient-rated wrist evaluation score (PRWE). The average follow-up period was 25 (range: 12-97) months. All radius and scaphoid fractures healed. The mean active wrist motions were found to be 45 degrees of flexion, 48.5 degrees of extension, 20 degrees of radial deviation, and 43 degrees ulnar deviation. Mean grip/pinch strengths were 31/8.5 kg. Mean PRWE score was 5.5 (range: 0-8.5). All patients returned to preoperative activity level and can do preinjury jobs. Combined ipsilateral fractures of distal radius and scaphoid are complex and rare injuries due to high energy traumas. Stable early primary fracture fixation in these injuries can be expected with good functional results. Level IV.

Fraturas do rádio distal associadas à fratura do escafoide

“…Most subjects were males (73.4%), in the fourth decade of life (average age, 38.4 years old), consistent with the literature. 2,4,7,9,[13][14][15][16][17][18][19] The fractures presented a comminuted pattern, strengthening the hypothesis of high-energy trauma, corresponding to subgroup C per the AO/ASIF Classification (21 patients). Most (86%) scaphoid fractures presented a simple line at waist level without displacement, and the remaining 14% of fractures occurred at the proximal pole of the scaphoid.…”

“…This represents a significant sample given the low prevalence of this injury and the researched literature, which reportedly has only five publications with considerable sample sizes. 2 3 4 13 19 The largest series identified was published by Vukov et al (1988) 13 and had 26 patients. However, all subjects received conservative treatment, which resulted in a high rate of complications (57%).…”

“… 1 Meanwhile, scaphoid fractures are the most frequent among carpal bones. However, the simultaneous occurrence of distal radial and scaphoid fractures is rare 2 , and it often results from high-energy trauma. The literature reports its incidence in 0.5 to 5% of distal radial fractures.…”

“…As fraturas isoladas do rádio distal são comuns, apresentando alta incidência na população, 1 enquanto as fraturas do escafoide são as mais frequentes entre os ossos do carpo. No entanto, a ocorrência simultânea de fraturas da extremidade distal do rádio e do escafoide é uma condição rara, geralmente decorrente de traumas de alta energia, 2 com uma incidência relatada na literatura de 0,5 a 5% das fraturas do rádio distal. 3 …”

Bilateral combined fractures of the scaphoid and distal radius: a case report

“…Bilateral combined association of these fractures is extremely rare and results due to high-energy trauma [ 1 , 6 ]. There is no consensus regarding the mechanism of injury [ 7 ]. Because fractures of the scaphoid involve extension and ulnar deviation of the wrist to place the scaphoid in a vertical and vulnerable position with three-point bending stresses applied, it seems likely that the scaphoid fracture occurs first and then continued axial loading and extension of the wrist results in the fractures of the radius [ 8 , 9 ].…”