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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 1, 66-71.
doi: 10.1302/0301-620X.90B1.19767  
Copyright © 2008 by British Editorial Society of Bone and Joint Surgery
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Percutaneous screw fixation versus conservative treatment for fractures of the waist of the scaphoid

A PROSPECTIVE RANDOMISED STUDY

M. M. McQueen, MD, FRCSEd(Orth), Consultant Orthopaedic Trauma Surgeon1; M. K. Gelbke, MD, Orthopaedic Surgery Resident2; A. Wakefield, MSc, MCSP, Research Physiotherapist3; E. M. Will, MCSP, Research Physiotherapist1; and C. Gaebler, MD, PhD, Professor4

1 Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Old Dalkeith Road, Edinburgh EH16 4SU, UK.
2 Department of Orthopaedic Surgery, University of Michigan, 1500 E Medical Center Drive, 2912D Taubman Center, Ann Arbor, Michigan 48109, USA.
3 Trauma and Orthopaedics, F Level MP 45 Southampton General Hospital, Tremona Road, Southampton SI6 6YD, UK.
4 Facharzt für Unfallchirurgie und Sporttraumatologie, Medizinische Universität Wien, University Klinik für Unfallchirurgie Währinger Gürtel 18-20, A-1090 Wien, Austria.

Correspondence should be sent to Miss M. M. McQueen; e-mail: mmcqueen{at}staffmail.ed.ac.uk

We randomly allocated 60 consecutive patients with fractures of the waist of the scaphoid to percutaneous fixation with a cannulated Acutrak screw or immobilisation in a cast. The range of movement, the grip and pinch strength, the modified Green/O’Brien functional score, return to work and sports, and radiological evidence of union were evaluated at each follow-up visit. Patients were followed sequentially for one year.

Those undergoing percutaneous screw fixation showed a quicker time to union (9.2 weeks vs 13.9 weeks, p < 0.001) than those treated with a cast. There was a trend towards a higher rate of nonunion in the non-operative group, although this was not statistically significant. Patients treated by operation had a more rapid return of function and to sport and full work compared with those managed conservatively. There was a very low complication rate.

We recommend that all active patients should be offered percutaneous stabilisation for fractures of the waist of the scaphoid.




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Time to union and rate of nonunion in scaphoid fractures
R Adam Brooks
J Bone Joint Surg Br Online, 17 Sep 2008 [Full text]

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Registered charity no: 209299     Print ISSN: 0301-620X
Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General