gms | German Medical Science

Objectives/Interrogation: Ipsilateral fractures of the distal radius and scaphoid are rare, approximately 0,7 to 4% of all upper extremity fractures, with few reports described. Headless screw fixation is the current gold standard of surgical repair for scaphoid fractures. However, maintaining reduction of certain types of scaphoid fractures is challenging with a compression screw.

Methods: 44-year-old woman arrived into our hospital due to precipitation of second floor. Radiographs showed pelvic fracture and closed left distal radius fracture (type A3 of AO classification) and left scaphoid fracture (type B2 of the Hebert classification). After stabilization of the patient and performed the first damage control; definitive surgery was performed 5 days later. Open reduction and internal fixation of radius fracture was performed with an Aptus plate. Initially, percutaneous reduction of the scaphoid fracture was attempted with percutaneous screw, but stabilization was not achieved due to poor bone quality. Intraoperative radiographs showed comminution and third fracture fragment, so volar approach and open reduction and internal fixation reduction with AptusHand was performed. After a rehabilitation program, excellent functional result was achieved, with a joint balance of supination/pronation 80º-85º, radial/ulnar inclination 25º-30º, full fist closure and 6mm sensibility discrimination in all fingers. No pseudoartrosis was observed.

Results and Conclusions: Recent series, reintroduced volar plating as a valid fixation option in a small subset of scaphoid fractures. Plate fixation may offer superior fixation, particularly those with comminution, nonunion, segmental bony defects, and osteopenic or osteoporotic bone. CT scan could by necessary in this type of radius associated with scaphoid fracture because of usually result of high-energy mechanisms and radiographs cannot see the comminution, specially on scaphoid bone. Goodwin J et al. reported this year that there were no differences in load to failure between fixation methods In simulated osteoporotic bone, the locking plate had a 28% greater load to failure as compared with screw fixation.

Consideration of bone quality is also important when choosing a method of fixation. In cases of comminution scaphoid fractures, locking plate fixation is better to achieved a good anatomic reduction and stabilization of the fracture with excellent functional outcomes.