gms | German Medical Science

Objectives/Interrogation: In acute scaphoid fractures, immobilization up until 12 weeks may be required. However, literature describes that when any resorption at the fracture site suggests that the fracture will not heal by continued immobilization alone it will require surgery. Also, fractures that were delayed in diagnosis may show signs of failed healing and may require an operation.

Methods: We retrospectively investigated our patient cohort with scaphoid fractures which had a delay in diagnosis or showed delayed fracture healing, and were treated by percutaneous screw fixation. We compared them to patients from the same cohort, who were treated by open reduction, bone grafting and screw fixation. The method of treatment was decided by cyst or resorption seam diameter. Patients who needed wide resection of a pseudo-arthrosis were excluded. We investigated the time to radiographically confirmed fracture healing, range of motion and return to work.

Results and Conclusions: We included six patients, 1 female and 5 males, treated by closed reduction and percutaneous screw fixation with a mean of 63.5 days since trauma and compared them to six patients, all male, who were treated by open screw fixation and bone grafting after a mean of 68.3 days. In the openly treated group, the mean diameter of cysts or seam formation was 3.2 mm, in the closed group 1.9 mm. Exclusively in the open treated group, two patients with dislocated fractures were treated. The patients in the closed reduction group had a mean age of 36.7 years, the openly treated patients 31.2 years. The percutaneously treated fractures all healed after a median of 11.5 weeks. In the openly treated group, one fracture did not heal and needed surgery using the Matti-Russe technique 14 months postoperatively. The remaining fractures healed after a median of 9 weeks. Range of motion extension/flexion in the closed group was 70/0/70 degrees, in the open treated group 56/0/59 degrees. Patients in the open reduction group returned to work after a mean of 13 weeks, the patients in the closed reduction group after a mean of 9.6 weeks.

Concluding, in our experience, in case of failing signs of fracture healing in the scaphoid, delayed percutaneous screw fixation is a good option in case of a resorption seam with small cysts or no cyst formation at all. In case of larger cysts or dislocation, open reduction with screw fixation shows to be effective in most cases in our cohort.