Scaphoid Fracture - Overview and Conservative Treatment

Abstract

Scaphoid fracture is the most common fracture in carpal bones. Although the reported union rate of conservatively-treated fractures is more than 90%, there is a controversy over the most appropriate treatment. In recent years, many reports have compared the clinical outcomes of conservatively-treated scaphoid fractures with the results of operatively treated ones using randomized controlled trials and meta-analyses. However, there is no consensus regarding the optimal treatment. In this paper, based on literature review, we provide an overview of the management of the acute scaphoid fractures particularly focusing on the issues related to conservative treatment.

Conservatively Managed, Displaced Scaphoid Fracture in a Young, Female Collegiate Basketball Player

“…Scaphoid fractures are the most frequent carpal fracture [4]. It is the second most common fractured bone in the upper extremity after the distal radius [5].…”

Controversies and best practices for acute scaphoid fracture management

“…Heeding these weakness, recommendations for the best practices for acute scaphoid fracture management would include: A combination of physical examination tests (tenderness in the anatomical snuffbox, pain on palpation of the scaphoid tubercle, pain with axial compression of the thumb and painful thumb range of motion) should be used to increase the specificity to detect an occult scaphoid fracture (Bergh et al., 2014; Duckworth et al., 2012; Parvizi et al., 1998). Early advanced imaging such as a CT or MRI within the first week of injury should be considered for high-demand patients who present with radial-sided wrist pain and negative radiographs and who wish to avoid unnecessary cast immobilization (Bergh et al., 2014; Kelson et al., 2016; Khalid et al., 2010; Tada et al., 2015). Inclusion of the thumb in a cast has not been shown to increase scaphoid union rates or accelerate time to union (Buijze et al., 2014; Clay et al., 1991; Doornberg et al., 2011).…”

“…Early advanced imaging such as a CT or MRI within the first week of injury should be considered for high-demand patients who present with radial-sided wrist pain and negative radiographs and who wish to avoid unnecessary cast immobilization (Bergh et al., 2014; Kelson et al., 2016; Khalid et al., 2010; Tada et al., 2015).…”

Determining diagnosis of scaphoid healing: Comparison of cone beam CT and X-ray after six weeks of immobilization

“…Overall, 75 % of the scaphoid surface is covered by cartilage, and its blood supply mainly originates from the radial artery with a retrograde blood flow [5]. This specific configuration increases the risk of pseudarthrosis in fracture cases, as the blood flow to the proximal part is easily compromised [6,7]. Hence, if a fracture is poorly treated or even unrecognized beyond four weeks after the trauma, the risk of non-union can reach up to 45 % [8].…”