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Current concepts for the treatment of acute scaphoid fractures

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Abstract

Fractures of the scaphoid are common injuries, accounting for approximately 80 % of carpal fractures. Differentiation between stable and unstable fractures (Herbert classification) cannot be made with conventional X-rays, so evaluation by computed tomography should additionally be performed. Under most circumstances, minimally invasive surgery with cannulated screws is the treatment of choice. A longer cast immobilization after minimal-invasive surgery is not necessary. Conservative treatment still has a place if the fracture is not dislocated nor unstable, but operative treatment can be offered to reduce the period of cast immobilization. Displaced fractures have a greater risk for nonunion and therefore should be treated operatively. Proximal pole fractures are definitely unstable, requiring treatment with screw fixation. The surgical approach depends on the location of the fracture and the preference of the surgeon.

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References

  1. Baumeister HH, Greinemann H. Conservative treatment of scaphoid bone fracture of the wrist. Unfallchirurg. 1989;92(4):175–9.

    CAS  PubMed  Google Scholar 

  2. Brauer RB, Dierking M, Werber KD. Use of the Herbert screw with the freehand method for osteosynthesis of acute scaphoid fracture. Unfallchirurg. 1997;100(10):776–81.

    Article  CAS  PubMed  Google Scholar 

  3. Rettig AC, Kollias SC. Internal fixation of acute stable scaphoid fractures in the athlete. Am J Sports Med. 1996;24(2):182–6.

    Article  CAS  PubMed  Google Scholar 

  4. Schaefer M. Siebert HR Fracture of the semilunar bone. Unfallchirurg. 2002;105(6):540–52.

    Article  CAS  PubMed  Google Scholar 

  5. Bond CD, et al. Percutaneous screw fixation or cast immobilization for nondisplaced scaphoid fractures. J Bone Joint Surg Am. 2001;83-A(4):483–8.

    CAS  PubMed  Google Scholar 

  6. Lennert KH, Contzen H. Conservative treatment of fractures of the scaphoid bone — indications. Unfallchirurgie. 1988;14(3):148–50.

    CAS  PubMed  Google Scholar 

  7. Berger RA. The anatomy of the scaphoid. Hand Clin. 2001;17(4):525–32.

    CAS  PubMed  Google Scholar 

  8. Reigstad O, et al. Scaphoid non-unions, where do they come from? The epidemiology and initial presentation of 270 scaphoid non-unions. Hand Surg. 2012;17(3):331–5.

    Article  PubMed  Google Scholar 

  9. Mehling IM, Sauerbier M. Scaphoid fractures and pseudarthrosis of the scaphoid. Z Orthop Unfallchirurgie. 2013;151(6):639–60.

    Article  CAS  Google Scholar 

  10. Krimmer H, Schmitt R, Herbert T. Scaphoid fractures: diagnosis, classification and therapy. Unfallchirurg. 2000;103(10):812–9.

    Article  CAS  PubMed  Google Scholar 

  11. Sauerbier M, Germann G, Dacho A. Current concepts in the treatment of scaphoid fractures. Eur J Trauma. 2004;2:80–92.

    Google Scholar 

  12. Schmitt R, Lanz U Bildgebende Diagnostik der Hand 2015, Stuttgart Georg Thieme Verlag KG.

  13. Memarsadeghi M, et al. Occult scaphoid fractures: comparison of multidetector CT and MR imaging—initial experience. Radiology. 2006;240(1):169–76.

    Article  PubMed  Google Scholar 

  14. Herbert T. The fractured scaphoid 1990, St. Louis: quality medical publishing.

  15. Herbert TJ, Fisher WE. Management of the fractured scaphoid using a new bone screw. J Bone Joint Surg Br. 1984;66(1):114–23.

    CAS  PubMed  Google Scholar 

  16. Krimmer H. Post-traumatic carpal collapse: follow-up and therapeutic concept. Unfallchirurg. 2000;103(4):259.

    Article  CAS  PubMed  Google Scholar 

  17. Herbert TJ, Krimmer H. Scaphoid fractures—internal fixation using the Herbert screw system. In: Master techniques in orthopaedic surgery: the wrist. New York: Raven Press; 2000.

    Google Scholar 

  18. Bickert B, et al. Use of a cannulated 3.0 mm AO screw with an intraosseous support washer in osteosynthesis of the scaphoid: results and analysis of problems in 28 cases. Handchir Mikrochir Plast Chir. 2000;32(4):277–82.

    Article  CAS  PubMed  Google Scholar 

  19. Herbert TJ, Fisher WE, Leicester AW. The Herbert bone screw: a 10-year perspective. J Hand Surg Br. 1992;17(4):415–9.

    Article  CAS  PubMed  Google Scholar 

  20. Schädel-Hopfner M, Bohringer G, Gotzen L. Percutaneous osteosynthesis of scaphoid fracture with the Herbert-Whipple screw—technique and results. Handchir Mikrochir Plast Chir. 2000;32(4):271–6.

    Article  PubMed  Google Scholar 

  21. Bond CD, Shin CA. Percutaneous cannulated screw fixation of acute scaphoid fractures. Tech Hand Up Extrem Surg. 2000;4(2):81–7.

    Article  CAS  PubMed  Google Scholar 

  22. Chan KW, McAdams TR. Central screw placement in percutaneous screw scaphoid fixation: a cadaveric comparison of proximal and distal techniques. J Hand Surg Am. 2004;29(1):74–9.

    Article  PubMed  Google Scholar 

  23. Kamineni S, Lavy CB. Percutaneous fixation of scaphoid fractures. An anatomical study. J Hand Surg Br. 1999;24(1):85–8.

    Article  CAS  PubMed  Google Scholar 

  24. Wozasek GE, Moser KD. Percutaneous screw fixation for fractures of the scaphoid. J Bone Joint Surg Br. 1991;73(1):138–42.

    CAS  PubMed  Google Scholar 

  25. Barton NJ. Twenty questions about scaphoid fractures. J Hand Surg Br. 1992;17(3):289–310.

    Article  CAS  PubMed  Google Scholar 

  26. Wu WC. Percutaneous cannulated screw fixation of acute scaphoid fractures. Hand Surg. 2002;7(2):271–8.

    Article  PubMed  Google Scholar 

  27. Sauerbier M, Müller M. Scaphoid fractures: diagnosis, surgical approach, and complications. Zentralblatt Chir. 2007;132(3):W42–53.

    Article  CAS  Google Scholar 

  28. Jeon IH, et al. Minimal invasive percutaneous Herbert screw fixation in acute unstable scaphoid fracture. Hand Surg. 2003;8(2):213–8.

    Article  PubMed  Google Scholar 

  29. Haddad FS, Goddard NJ. Acute percutaneous scaphoid fixation. A pilot study. J Bone Joint Surg Br. 1998;80(1):95–9.

    Article  CAS  PubMed  Google Scholar 

  30. Chung KC. A simplified approach for unstable scaphoid fracture fixation using the Acutrak screw. Plast Reconstr Surg. 2002;110(7):1697–703.

    Article  PubMed  Google Scholar 

  31. Adolfsson L, Lindau T, Arner M. Acutrak screw fixation versus cast immobilisation for undisplaced scaphoid waist fractures. J Hand Surg Br. 2001;26(3):192–5.

    Article  CAS  PubMed  Google Scholar 

  32. Krimmer H. Scaphoid fracture repair using the Herbert screw system (HBS). Atlas of the Hand Clin. 2003;8:57–66.

    Article  Google Scholar 

  33. Krimmer H. Management of acute fractures and nonunions of the proximal pole of the scaphoid. J Hand Surg Br. 2002;27(3):245–8.

    Article  CAS  PubMed  Google Scholar 

  34. Sauerbier M, et al. Midcarpal arthrodesis with complete scaphoid excision and interposition bone graft in the treatment of advanced carpal collapse (SNAC/SLAC wrist): operative technique and outcome assessment. J Hand Surg Br. 2000;25(4):341–5.

    Article  CAS  PubMed  Google Scholar 

  35. Sauerbier M, Werner A. Diagnosing and treating scaphoid fractures. Eur Musculoskelet Rev. 2011;6(2):120–4.

    Google Scholar 

  36. Slade JF, Gutow AP. Geissler WB Percutaneous internal fixation of scaphoid fractures via an arthroscopically assisted dorsal approach. J Bone Joint Surg Am. 2002;84-A(Suppl 2):21–36.

    PubMed  Google Scholar 

  37. Slade JF, Grauer JN. Mahoney JD Arthroscopic reduction and percutaneous fixation of scaphoid fractures with a novel dorsal technique. Orthop Clin North Am. 2001;32(2):247–61.

    Article  PubMed  Google Scholar 

  38. Slade JF, et al. Percutaneous internal fixation of selected scaphoid nonunions with an arthroscopically assisted dorsal approach. J Bone Joint Surg Am. 2003;85-A(Suppl 4):20–32.

    PubMed  Google Scholar 

  39. Geissler WB, et al. Scaphoid fractures: what’s hot, what’s not. J Bone Joint Surg Am. 2012;94(2):169–81.

    Article  PubMed  Google Scholar 

  40. Arnoldi V, et al. Erste Erfahrungen mit einer winkelstabilen Skaphoidspezialplatte. Kongr Dtsch Ges Handchir. Baden-Baden 2014.

  41. Schädel-Hopfner M, et al. Operative versus conservative treatment of non-displaced fractures of the scaphoid bone. Results of a controlled multicenter cohort study. Unfallchirurg. 2010;113(10):804–6.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors thank medical student Jack Squiers for editing the manuscript and librarian Claudia Diemann-Paeth for assisting with the literature research.

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Authors and Affiliations

  1. Department for Plastic, Hand and Reconstructive Surgery, Hand Trauma Center, BG Trauma Center Frankfurt am Main, Academic Hospital Goethe University Frankfurt a. Main, Friedberger Landstrasse 430, 60389, Frankfurt am Main, Germany

    A. Arsalan-Werner, M. Sauerbier & I. M. Mehling

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  1. A. Arsalan-Werner
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  2. M. Sauerbier
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  3. I. M. Mehling
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Corresponding author

Correspondence to M. Sauerbier.

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Conflict of interest

Prof. Dr. med. Dr. med. habil. M. Sauerbier has an advisory contract with Medartis AG, Basel, Switzerland. Dr. med. Annika Arsalan-Werner and PD Dr. med. Isabella M. Mehling declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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

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  • DOI: https://doi.org/10.1007/s00068-015-0587-8

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