gms | German Medical Science

Objectives/Interrogation: To investigate the causation of scaphoid fracture nonunions which underwent bone graft surgery at 20 centres within the UK.

Methods: Data was collected from the hospital records of 796 patients undergoing scaphoid fracture nonunion surgery. This was completely by a collaboration of clinicians who were part of the scaphoid non union group.

Results: 306 and 346 of patients presented to the NHS within 2 and 4 weeks respectively of the acute scaphoid fracture. 305 and 223 presented over 4 weeks and 12 weeks respectively of their fracture (incomplete data in 145 instances).

Of the 306 who presented within 2 weeks, appropriate treatment for the acute fracture was started within 2 and 4 weeks respectively in 172 and 188 cases. 74 of these 306 had no treatment during the first 13 weeks post-injury.

Patients who sought medical advice within 2 weeks but did not commence any treatment until after 4 weeks attended 1-4 different health resources before their fracture was diagnosed. Data from 121 of these cases showed first attendances with an Emergency Department (79), GP (10), Minor Injuries unit (20), Therapist (2), Walk-In Centre (5) and Fracture/Hand Clinic (2). Of the 79 who first attended an Emergency Department, 66 required attendances with 2-4 further health resources before their fracture was diagnosed.

Conclusion: This data show the present mechanisms for managing acute scaphoid fractures are failing, and causing the majority of scaphoid fracture nonunions. The problem is probably multifactorial with issues regarding patient awareness of the possibility of a fracture and compliance with treatment, and difficulties with the diagnosis of scaphoid fractures by health professionals. Efforts should be concentrated on addressing these issues, and also improving the success rate of surgery to treat scaphoid fracture nonunions.