Conservative therapy of scaphoid waist fractures

Česká verzia

Authors: Martin Vlček ; S. Štefanisko; J. Pech; D. Veigl
Authors place of work: Ortopedická klinika 1. LF UK a FN v Motole, Praha
Published in the journal: Rozhl. Chir., 2024, roč. 103, č. 10, s. 400-405.
doi: https://doi.org/10.48095/ccrvch2024400

Summary

Introduction: The goal of this work is to determine, using the analysis of our own patient group and current professional publications, in which cases fractures of the scaphoid waist can be treated conservatively by short-term plaster fixation with a low risk of non-union developing.

Material and method: A group of 19 patients (17 men and 2 women) with the mean age 31 years (range 20–43, SD 7.3) with fractures of scaphoid waist were indicated for conservative treatment. The diagnosis was made on the basis of X-ray and CT examination. Conservative therapy consisted of applying plaster fixation of the wrist and thumb for a minimum of 6 weeks in completely non-dislocated fractures (mean 6.4 weeks, range 6–10 weeks). The other fractures were immobilized with a plaster cast for a total of 9 weeks. All patients were followed for at least 6 months.

Results: At 6 months after the injury, 2 of the patients reported mild pain at rest (1× with healed fracture, 1× with a non-union). Pain during movement occurred in 5 patients with a developed non-union. Good healing of the fracture in the anatomical position was observed in 10 patients (53%), in 2 cases (11%) an angular dislocation occured during healing, and in 7 patients (37%) the result of treatment was a non-union.

Conclusion: Conservative therapy is suitable for fractures of the scaphoid waist without dislocation and with dislocation of bone fragments up to 1.5 mm. In these fractures, conservative therapy has a low risk of non-union developing. X-ray imaging is insufficient. In case the fracture line does not appear on the X-ray and there is a significant clinical finding, especially in the group of patients with a typical occurrence of a fracture of the scaphoid waist, i.e. in young men aged between 25 and 40 years, CT examination must be performed. The decision on the type of treatment must always be based on the CT scan.

Keywords:

non-union – fracture – conservative therapy – scaphoid

Zdroje

1. Dylevský I, Mrzena V. Os scaphoideum – functional and clinical anatomy. Acta Chir Orthop Traumatol Cech 2001; 68(5): 327–330.

2. Oehmke HJ. Blood supply and function of the scaphoid bone. Unfallchirurgie 1987; 13(3): 174–177. doi: 10.1007/BF02588423.

3. Sendher R, Ladd AL. The scaphoid. Orthop Clin North Am 2013; 44(1): 107–120. doi: 10.1016/j.ocl.2012.09.003.

4. Arsalan-Werner A, Sauerbier M, Mehling IM. Current concepts for the treatment of acute scaphoid fractures. Eur J Trauma Emerg Surg 2016; 42(1): 3–10. doi: 10.1007/s00068-015-0587-8.

5. Veigl D, Vlček M, Sosna A. Zlomeniny a luxace v oblasti zápěstí a ruky. In: Sosna A, Fulín P, Pokorný D et al. Základy ortopedie a traumatologie pohybového aparátu. Praha: Triton 2024.

6. Wendsche P, Veselý R. Traumatologie. Praha: Galén 2019.

7. Hove LM. Epidemiology of scaphoid fractures in Bergen, Norway. Scand J Plast Reconstr Surg Hand Surg 1999; 33(4): 423–426. doi: 10.1080/02844319950159145.

8. Tada K, Ikeda K, Okamoto S et al. Scaphoid fracture – overview and conservative treatment. Hand Surg 2015; 20(2): 204–209. doi: 10.1142/S0218810415400018.

9. Reigstad O, Thorkildsen R, Grimsgaard C et al. Examination and treatment of scaphoid fractures and pseudarthrosis. Tidsskr Nor Laegeforen 2015; 135(12–13): 1138–1142. doi: 10.4045/tidsskr.14.1256.

10. Dias J, Brealey S, Choudhary S et al. Scaphoid waist internal fixation for fractures trial (SWIFFT) protocol: a pragmatic multi-centre randomised controlled trial of cast treatment versus surgical fixation for the treatment of bi-cortical, minimally displaced fractures of the scaphoid waist in adults. BMC Musculoskelet Disord 2016; 17: 248. doi: 10.1186/s12891-016-1107-7.

11. Raittio LT, Jokihaara J, Huttunen TT et al. Rising incidence of scaphoid fracture surgery in Finland. J Hand Surg Eur Vol 2018; 43(4): 402–406. doi: 10.1177/1753193417726051.

12. Maňák P, Dráč P. Non-union in os scaphoideum and its surgical treatment: overview of literature. Acta Chir Orthop Traumatol Cech 2004; 71(5): 311–315.

13. Clementson M, Thomsen N, Björkman A. Scaphoid fractures – guidelines for diagnosis and treatment. Lakartidningen 2019; 116: FL9M.

14. Fousek J, Indráková P, Vanĕcek V. Management of pseudoarthrosis of the navicular bone of the wrist using the Synthes 3.0 screw. Rozhl Chir 2005; 84(11): 561–566.

15. Gray RRL, Halpern AL, King SR et al. Scaphoid fracture and nonunion: new directions. J Hand Surg Eur Vol 2023; 48(2_suppl): 4S–10S. doi: 10.1177/17531934231165419.

16. Klifto CS, Ramme AJ, Sapienza A et al. Scaphoid nonunions. Bull Hosp Jt Dis 2018; 76(1): 27–32.

17. Carpenter CR, Pines JM, Schuur JD et al. Adult scaphoid fracture. Acad Emerg Med 2014; 21(2): 101–121. doi: 10.1111/acem.12317.

18. Parvizi J, Wayman J, Kelly P et al. Combining the clinical signs improves diagnosis of scaphoid fractures. A prospective study with follow-up. J Hand Surg 1998; 23(3): 324–327. doi: 10.1016/s0266-7681(98)80050-8.

19. Jørgsholm P, Thomsen NO, Besjakov J et al. The benefit of magnetic resonance imaging for patients with posttraumatic radial wrist tenderness. J Hand Surg Am 2013; 38(1): 29–33. doi: 10.1016/j.jhsa.2012.09.034.

20. Prommersberger KJ. Scaphoid fractures and scaphoid non-unions. Handchir Mikrochir Plast Chir 2020; 52(5): 372. doi: 10.1055/a-1241-0567.

21. Clementson M, Thomsen N, Jørgsholm P et al. Is early mobilisation better than immobilisation in the treatment of wrist sprains? J Plast Surg Hand Surg 2016; 50(3): 156–160. doi: 10.3109/2000656X.2015.1137925.

22. Geijer M. Diagnosis of scaphoid fracture: optimal imaging techniques. Rep Med Imaging 2013; 6(1): 57–69. doi: 10.2147/RMI.S48951.

23. Clementson M, Jørgsholm P, Besjakov J et al. Union of scaphoid waist fractures assessed by CT scan. J Wrist Surg 2015; 4(1): 49–55. doi: 10.1055/s-0034-1398472.

24. Strelzow J, Grewal R. Predicting union of scaphoid fractures. In: Buijze G, Jupiter J. Scaphoid fractures. Evidence-based management. St Louis: MO Elsevier 2018: 199–208.

25. Karle B, Mayer B, Kitzinger HB et al. Scaphoid fractures – operative or conservative treatment? A CT-based classification. Handchir Mikrochir Plast Chir 2005; 37(4): 260–266. doi: 10.1055/s-2005-865895.

26. Amirfeyz R, Bebbington A, Downing ND et al. Displaced scaphoid waist fractures: the use of a week 4 CT scan to predict the likelihood of union with nonoperative treatment. J Hand Surg Eur Vol 2011; 36(6): 498–502. doi: 10.1177/1753193411403092.

27. Jernigan EW, Morse KW, Carlson MG. Managing the athlete with a scaphoid fracture. Hand Clin 2019; 35(3): 365–371. doi: 10.1016/j.hcl.2019.03.011.

28. Suh N, Grewal R. Controversies and best practices for acute scaphoid fracture management. J Hand Surg Eur Vol 2018; 43(1): 4–12. doi: 10.1177/1753193417735973.

29. Chen S, Zhang C, Jiang B et al. Comparison of conservative treatment and surgery treatment for acute scaphoid fracture: a meta-analysis of randomized controlled trials. World J Surg 2023; 47(3): 611–620. doi: 10.1007/s00268-022-06833-1.

30. Buijze GA, Doornberg JN, Ham JS et al. Surgical compared with conservative treatment for acute nondisplaced or minimally displaced scaphoid fractures: a systematic review and meta-analysis of randomized controlled trials. J Bone Joint Surg Am 2010; 92(6): 1534–1544. doi: 10.2106/JBJS.I.01214.

31. Mathoulin CL, Arianni M. Treatment of the scaphoid humpback deformity – is correction of the dorsal intercalated segment instability deformity critical? J Hand Surg Eur Vol 2018; 43(1): 13–23. doi: 10.1177/1753193417739526.

32. Langhoff O, Andersen JL. Consequences of late immobilization of scaphoid fractures. J Hand Surg Br 1988; 13(1): 77–79. doi: 10.1016/0266-7681_88_90058-7.

33. Buijze GA, Goslings JC, Rhemrev SJ et al. Cast immobilization with and without immobilization of the thumb for nondisplaced and minimally displaced scaphoid waist fractures: a multicenter, randomized, controlled trial. J Hand Surg Am 2014; 39(4): 621–627. doi: 10.1016/j.jhsa.2013.12.039.

34. Singh HP, Taub N, Dias JJ. Management of displaced fractures of the waist of the scaphoid: meta-analyses of comparative studies. Injury 2012; 43(6): 933–939. doi: 10.1016/j.injury.2012.02.012.

35. Johnson NA, Fairhurst C, Brealey SD et al. One-year outcome of surgery compared with immobilization in a cast for adults with an undisplaced or minimally displaced scaphoid fracture: a meta-analysis of randomized controlled trials. Bone Joint J 2022; 104-B(8): 953–962. doi: 10.1302/0301-620X.104B8.BJJ-2022-0085.R2.

36. Li NY, Dennison DG, Shin AY et al. Update to management of acute scaphoid fractures. J Am Acad Orthop Surg 2023; 31(15): e550–e560. doi: 10.5435/JAAOS-D-22-01210.

37. Davis TR. Prediction of outcome of non-operative treatment of acute scaphoid waist fracture. Ann R Coll Surg Engl 2013; 95(3): 171–176. doi: 10.1308/003588413X13511609956895.

38. Dias JJ, Brealey SD, Fairhurst C et al. Surgery versus cast immobilisation for adults with a bicortical fracture of the scaphoid waist (SWIFFT): a pragmatic, multicentre, open-label, randomised superiority trial. Lancet 2020; 396(10248): 390–401. doi: 10.1016/S0140-6736(20)30931-4.

MUDr. Martin Vlček, Ph.D.

Ortopedická klinika

1. LF UK a FN v Motole

V Úvalu 84

150 06 Praha 5

dr.martinvlcek@gmail.com

ORCID autora

M. Vlček 0000-0002-9857-6790