gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Displaced scaphoid type B2 waist fractures stabilized by one or two headless compression screws

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  • presenting/speaker Stefan Quadlbauer - AUVA Trauma Hospital Lorenz Böhler, Wien, Austria
  • Thomas Beer - AUVA Trauma Hospital Lorenz Böhler, Wien, Austria
  • Christoph Pezzei - AUVA Trauma Hospital Lorenz Böhler, Wien, Austria
  • Josef Jurkowitsch - AUVA Trauma Hospital Lorenz Böhler, Wien, Austria
  • Tina Keuchel - AUVA Trauma Hospital Lorenz Böhler, Wien, Austria
  • Thomas Hausner - AUVA Trauma Hospital Lorenz Böhler, Wien, Austria
  • Martin Leixnering - AUVA Trauma Hospital Lorenz Böhler, Wien, Austria

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-995

doi: 10.3205/19ifssh0504, urn:nbn:de:0183-19ifssh05047

Published: February 6, 2020

© 2020 Quadlbauer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: Scaphoid fractures are rare and account only 2 - 3 % of all fractures and 10 % of all hand fractures. Displaced scaphoid fractures are treated typically with headless bone screws, but a treatment with one screw will not lead to absolute stability.

Due to the complex and multidirectional movements of the scaphoid one screw is, specially against rotational forces, insufficient. Therefore, some authors started to use temporary anti-rotational K-wires.

The aim of this study was to compare radiological and clinical outcome of unstable scaphoid fractures, stabilized using one or two headless compression screws (HCS).

Methods: A total of 52 patients were included in this study with a mean follow up interval of 43 months. 22 patients were treated using one HCS and 30 with two HCS.

Clinical assessment included range of motion (ROM), pain according to the visual analogue scale (VAS), grip strength, the Disability of the Arm, Shoulder and Hand Score (DASH), the Patient Rated Wrist Evaluation (PRWE) Score, the Michigan Hand Outcomes Questionnaire (MHQ) and the modified Green O’Brien (Mayo) Wrist Score. All complications were documented.

The follow-up study on each patient included a CT-Scan of the wrist which was analysed for union, osteoarthritis, Dorsiflexed Intercalated Segment Instability and humpback deformity.

Results and Conclusions: Totally 49/52 (94%) of the scaphoid B2 type fractures showed union, 30/30 (100%) in the two HCS group and 19/22 (86%) in the one HCS group. Mean ROM in extension/flexion was 170° (range 80°-179°), in pronation/supination 178° (range 170°-180°) and radial/ulnar deviation 57° (range 30-60). Grip strength of 43 kg (92% of the uninjured hand). No significant differences could be found in respect to ROM, grip strength, VAS and Scores between the groups.

Conclusions: The unstable B2 type fractures of the scaphoid, when treated with two HCS and no bone grafting is a safe method, shows a higher union rate and equal clinical outcome compared to stabilization using only one HCS.