gms | German Medical Science

Objectives: Next to conservative treatment hand surgeons have several surgical options for recent scaphoid fractures such as a Headless Compression Screw (HCS) or plate osteosynthesis, with or without additional bone grafting. Scaphoid pseudarthroses (nonunion persisting for at least 6 months after injury) require surgical treatment. Since 2016 the "medartis 1.5 TriLockScaphoid Plate" has been available for the treatment of scaphoid fractures at the Department of Orthopedics and Traumatology at the University Hospital Graz. Therefore, in this study, we evaluated radiological and functional outcome and standardized patient self-assessment scores for all patients with scaphoid fractures after surgical osteosynthesis since March 2014.

Methods: The study included 13 surgically treated patients with scaphoid fractures between March 2014 and March 2019, 11 men and 2 women of mean age 39 years (22-66 years). Of these, 7 were recent fractures and 6 were pseudarthroses. All recent fractures were stabilized by HCS, one with additional bone grafting. 2 pseudarthroses were stabilized by HCS and bone grafting. The remaining 4 pseudarthroses were treated with plate osteosynthesis and bone grafting.

All 13 patients had a CT-scan of the wrist and were radiologically re-evaluated for humpback deformity, union of the fracture parts, postoperative osteoarthritis, dorsal intercalated segment instability (DISI) and scaphoid nonunion advanced collapse (SNAC). The functional outcome included the range of motion (ROM), the grip strength, the pain according to the numeric rating scale (NRS) and the Mayo and Krimmer scores. For the patients self-assessment we collected several standardized scores such as pain catastrophizing scale (PCS), disabilities of the arm, shoulder and hand (DASH), patient-rated wrist evaluation score (PRWE) and the Michigan hand questionaire (MHQ).

Results and Conclusion: All fractures had parts of united fracture fragments, mean union 75% (46-100%), on the last CT scans with a mean follow-up of 375 (47-1314 days) days. 8 can be classified as united (75-100%), 3 as partially united (50-75%) and two only as tenuously united (less than 50%). The functional scores, e.g. the Krimmer score with mean 79 points (40-100 points) showed good results. The mean dash score was excellent with 9 points (0-27 points).

The treatment of recent scaphoid fractures and scaphoid pseudarthroses at the University Hospital of Graz has resulted in good to moderate outcomes over this 5-year period. However, a prospective study with more patients would have to be planned for a meaningful evaluation.