A prospective study of acute undisplaced and minimally displaced scaphoid fractures managed by aggressive conservative approach

Bhat, Anil K and Acharya, Ashwath M and Manoh, S and Kamble, Vinay (2018) A prospective study of acute undisplaced and minimally displaced scaphoid fractures managed by aggressive conservative approach. The Journal of Hand Surgery (Asian-Pacific Volume), 23 (1). pp. 18-25. ISSN 2424-8355

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Abstract

Background: To identify acute un-displaced and minimally displaced scaphoid fractures which are unlikely to unite with non-operative treatment at six weeks with CT scan and stabilize them with percutaneous screw fixation with the aim of preventing non-union. Methods: A scaphoid series radiographs of wrist were obtained for patients with undisplaced or minimally displaced fractures and were immobilized in a thumb spica cast for six weeks. At six weeks, CT scan was done for patients showing doubtful signs of clinical and radiographic union. Patients with a gap less than 2 mm were continued on cast for an additional two to four weeks. Those with gap more than 2 mm underwent percutaneous screw fixation. In both cases the immobilisation was discontinued when the fracture was considered to be united and mobilization was initiated. Results: 21 out of 39 patients managed initially with cast for six weeks showed clinical and radiological evidence of union. 18 patients showed persistent tenderness of which eight showed a clear gap in radiographs and 10 patients had doubtful union. Eight of these 10 patients on CT scan showed fracture gap of more than 2 mm while two patients showed fracture gap of less than 2 mm. Hence, 16 patients underwent percutaneous fixation. Repeat radiographs showed progression to union at an average of 3.8 weeks from surgery. Remaining two eventually united on continuing the cast. All patients showed confirmed union at one year on follow up. Conclusions: An objective measurement of fracture gap by CT scan at six weeks is useful in predicting cases with tendency for delayed union. Early percutaneous fixation of fractures would not further jeopardize the blood supply of fracture site. This aggressive conservative management also avoids unnecessary surgery in all acute scaphoid fractures.

Item Type: Article
Uncontrolled Keywords: Scaphoid fracture; undisplaced fracture; percutaneous fixation.
Subjects: Medicine > KMC Manipal > Orthopaedics
Depositing User: KMC Library
Date Deposited: 07 Jan 2019 04:13
Last Modified: 07 Jan 2019 04:13
URI: http://eprints.manipal.edu/id/eprint/152753

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