Role of conservative vs operative treatment for acute scaphoid fractures

Abstract

Scaphoid fracture is a difficult fracture to deal with. This tiny twisted bone, 80% covered with joint cartilage and lying angulated by 45° in both planes deep in the wrist, has caused great frustrations among wrist surgeons. Diagnosis is difficult, classification is controversial & there is never ending debate on appropriate treatment protocol. Firstly, scaphoid fracture is prone to be missed in clinical assessment & is usually neglected as simple wrist injuries. Adding to that, this notorious fracture is often missed in first x-ray immediately after injury. Second line of investigation is a matter of debate & varies from doctor to doctor & centre to centre. This does not end here. Once diagnosed, there is no clear-cut protocol for deciding appropriate treatment technique. There is controversy regarding whether to be managed conservatively or operatively. Both have their own pros & cons. If managed conservatively, there is again no agreement in the literature as to the optimum position of immobilization (extension, ulnar deviation, neutral) or type of cast (thumb-spica, interphalangeal [IP] free/IP included, long arm/short arm). Last but the most nuisant are the complications. Scaphoid fracture is known for its complications like AVN, Non-union, arthritis owing to its peculiar blood supply, position in wrist & shape. Management of these complications are again not free of confusions & controversies. In this study we have tried our best to address these dilemmas & study this notorious bone in further detail.