Percutaneous Screw Fixation or Cast Immobilization for Nondisplaced Scaphoid Fractures

• Published in: Journal of bone and joint surgery. American volume Vol. 83; no. 4; p. 483
• Main Authors: Bond, Charles D, Shin, Alexander Y, McBride, Mark T, Dao, Khiem D
• Format: Journal Article
• Language: English
• Published: Boston, MA Copyright by The Journal of Bone and Joint Surgery, Incorporated 01-04-2001; Journal of Bone and Joint Surgery Incorporated; Journal of Bone and Joint Surgery AMERICAN VOLUME
• Edition: American volume
• Subjects: Adult; Biological and medical sciences; Bone Screws; Casts, Surgical; Diseases of the osteoarticular system. Orthopedic treatment; Female; Fracture Fixation; Fracture Fixation, Internal; Fracture Healing; Fractures, Bone - surgery; Humans; Linear Models; Male; Medical sciences; Military Personnel; Orthopedic surgery; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Scaphoid Bone - injuries; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Human; Prognosis; Orthopedic treatment; Diseases of the osteoarticular system; Internal; Immobilization; Osteosynthesis; Fracture; Trauma; Percutaneous route; Os naviculare carpi; Orthopedic surgery; Fixation; Treatment; Screw; Disease of the hand; Plaster; Upper limb; Bone; Technique; Comparative study
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/00004623-200104000-00001

Background:Nondisplaced scaphoid fractures treated with prolonged cast immobilization may result in temporary joint stiffness and muscle weakness in addition to a delay in return to sports or work. Fixation of scaphoid fractures with a percutaneous cannulated screw has resulted in a shorter time to union and to return to work or sports. The purpose of this prospective, randomized study was to compare cast immobilization with percutaneous cannulated screw fixation of nondisplaced scaphoid fractures with respect to time to radiographic union and to return to work.Methods:Twenty-five full-time military personnel with an acute nondisplaced fracture of the scaphoid waist consented to be randomized to either cast immobilization or fixation with a percutaneous cannulated Acutrak screw (Acumed, Beaverton, Oregon) for the purpose of this study. Time to fracture union, wrist motion, grip strength, and return to work as well as overall patient satisfaction at the time of a two-year follow-up were evaluated.Results:Eleven patients were randomized to percutaneous cannulated screw fixation, and fourteen were randomized to cast immobilization. The average time to fracture union in the screw fixation group was seven weeks compared with twelve weeks in the cast immobilization group (p = 0.0003). The average time until the patients returned to work was eight weeks compared with fifteen weeks in the cast immobilization group (p = 0.0001). There was no significant difference in the range of motion of the wrist or in grip strength at the two-year follow-up evaluation. Overall patient satisfaction was high in both groups.Conclusions:Percutaneous cannulated screw fixation of nondisplaced scaphoid fractures resulted in faster radiographic union and return to military duty compared with cast immobilization. The specific indications for and the risks and benefits of percutaneous screw fixation of such fractures must be determined in larger randomized, prospective studies.