Minimal Invasive Screw Fixation and Early Mobilization of Acute Scaphoid Fractures in the Middle Third

Abstract

Fractures of the scaphoid are relatively common injuries. Differentiation between stable and unstable fractures (Herbert classification) cannot always be made with conventional radiographs and should be additionally evaluated by computed tomographic scan. Under most circumstances, minimal invasive surgery with cannulated screws is currently the treatment of choice. Cast immobilization is not necessary. This article describes the technique of fracture fixation in the middle third of the scaphoid from a palmar approach and early functional outcomes. The outcome assessment included measurement of active range of motion as well as grip strength and the Disability of the Arm, Shoulder and Hand questionnaire as a measurement of activities of daily living. Fifty-four patients with acute scaphoid fractures were treated with minimal invasive screw fixation between April 2001 and January 2005. All patients in this retrospective study received a preoperative computed tomographic scan before surgery. Bony consolidation was found in 52 cases after 6 weeks; 2 patients required reosteosyntheses. The results demonstrate that minimal invasive screw fixation leads to satisfying functional outcomes within a few weeks.

An abnormally displaced scaphoid fracture: a case report

“…Magnetic resonance imaging had the best diagnostic performance, with the added benefit of soft tissue evaluation, but was the most expensive option. Muller et al [1], emphasized the difficulty of differentiation of stable and unstable scaphoid fractures with conventional radiographs and they stated that computed tomography scans should be performed. Many studies about the scaphoid fractures in the literature are focused on the diagnosis and appropriate treatment of these fractures but we could not find much for the abnormal displacement of the scaphoid fracture except an isolated dorsal fracture-dislocation of the scaphoid reported by Wanajo et al [8].…”

“…Differentiation between stable and unstable fractures is always not possible with conventional radiographs and should also be evaluated by computed tomographic scan [1]. Also the scaphoid fractures have the highest prevalence of nonunion in the human body [2].…”

Skaphoidfraktur und Skaphoidpseudarthrose

“…Horizontale oder quere Frakturen sowie Frakturen im Bereich des distalen Drittels haben eine bessere Prognose als vertikale Frakturen und Frakturen im proximalen Drittel [28,32].…”

Current management of acute scaphoid fractures: a review

“…6 Thus, arthroscopic-assisted surgery can treat both scaphoid fractures and carpal ligament injuries. 31 Arthroscopy also preserves the key ligaments and blood supply, allowing for immediate hand rehabilitation. 32…”