Fractures of the Scaphoid

Abstract

Fracture of the scaphoid is the most common injury of the carpus. Inadequate treatment frequently leads to non-union, which causes pain and serious disability. In the present study 134 scaphoid fractures treated during the period 1961-70 are reviewed. In fresh fractures less than 4 weeks old, bony union occurred in 95% with proper conservative treatment. The vexed question of whether a high or low circular cast should be used may not really be so important. In the present study, both methods of external splintage have given favourable results. It is indisputable, however, that other factors, such as the age of the fracture, its type and location are of great importance for the final result. It was also found that fracture dislocation greater than 1 mm regularly led to pseudarthrosis. Operative treatment is suggested in these cases, and the Matti-Russe technique has proved to be an excellent method for treatment of pseudarthrosis of the scaphoid. The study further confirmed that fractures of the scaphoid in children are more common than is usually supposed. They were all located in the distal two-thirds of the bone and it is suggested that this pattern of distribution is typical of childhood.

Herbert Screw Fixation of Scaphoid Fractures

“…Many authors still believe that the rate of union for conservative treatment of undisplaced fractures is about 95% (Osterman and Mikulics 1988;Gelberman et al 1989;Calandra et al 1992), but firm evidence for such optimism is lacking. Many papers do not have a clear definition of union and often base it on radiological appearance when the wrist comes out of plaster, or shortly after (Stewart 1954;London 1961;Eddeland et al 1975;Cooney et al 1980a;Leslie and Dickson 1981;Morgan and Walters 1984;Langhoff and Andersen 1988;Gellman et al 1989). Others have included cases in which the fracture line remains visible (Goldman, Lipscomb and Taylor 1969).…”

“…Internal fixation has yet to be accepted as a viable alternative to treatment in plaster for acute undisplaced fractures of the scaphoid (Eddeland et al 1975;Cooney, Dobyns and Linscheid 1980a;Leslie and Dickson 1981;Langhoff and Andersen 1988;Gellman et al 1989;Barton 1992;Calandra, Goldner and Hardaker 1992). For nonunion, some reports find no significant advantage over standard methods of bone grafting Svartengren 1987, 1989;Gelberman, Wolock and Siegel 1989;Hooning van Duyvenbode et al 1991;Calandra et al 1992).…”

Volar Percutaneous Screw Fixation for Scaphoid Waist Delayed Union

“…Several studies [6,17,20] that used cast immobilization for scaphoid delayed union had incidences of nonunion ranging from 19% to 88% and much longer immobilization periods (Table 3). Because the scaphoid resides intracapsularly, completely covered by cartilage, and possesses an odd undulating shape, it requires primary union for fracture healing.…”

Bone grafting the scaphoid nonunionA systematic review of 147 publications including 5 246 cases of scaphoid nonunion

“…The diagnosis may be missed by the patient not seeking medical examination and by the physician diagnosing a sprained wrist. Nonunion occurs in approximately 5% (0-22) (Stewart 1954, Eddeland et al 1975, Morgan and Walters 1984, Dias et al 1989, Larsen et al 1992, Duppe et al 1994, Barton 1997, Khan and Harby 1995, Raudasoja et al 1999, Roolker et al 1999). …”