Advertisement

Archives of Orthopaedic and Trauma Surgery

, Volume 130, Issue 9, pp 1117–1127 | Cite as

Acute non-displaced fractures of the scaphoid: earlier return to activities after operative treatment. A controlled multicenter cohort study

  • Michael Schädel-HöpfnerEmail author
  • Marta Marent-Huber
  • Emre Gazyakan
  • Karin Tanzer
  • Klaus D. Werber
  • Hartmut R. Siebert
Orthopaedic Surgery

Abstract

Introduction

To investigate whether operative treatment leads to earlier return to previous activity level, 94 patients with the same number of isolated, acute, complete, stable and non-displaced fractures of the scaphoid mid-third were involved in a prospective, multicenter cohort study.

Method

Fractures were either fixed with a cannulated screw or immobilized with a short arm cast, and followed for 6 months.

Results

By 15 weeks, patients receiving surgical treatment returned significantly earlier to their full time work and home activities, as well as achieved significantly better results for functional status, pain, and overall satisfaction. However, complication rates concerning union and secondary operative management were higher.

Conclusion

Operative treatment therefore primarily facilitates earlier return to previous activity level, as well as better functional status, less pain and higher patient satisfaction, yet conservative treatment seems to be safer and associated with a lower complication rate.

Keywords

Scaphoid fracture Operative treatment Convervative treatment Return to activities Return to work 

Notes

Acknowledgments

The authors would like to thank all participating study centers and the following lead clinical investigators for their dedication in conducting this study: T. Pillukat (Bad Neustadt), A. Eisenschenk (Berlin), K.H. Winker (Erfurt), G. Böhringer (Giessen), J.M. Rueger (Hamburg), H. Towfigh (Hamm), R. Arora (Innsbruck), E. Brück (Marburg), K. D. Werber (München), R. Slodicka (Rosenheim).

Furthermore, the authors would like to thank L. Audigé (AOCID) for statistical advice and M. Wilhelmi (AOCID) and D. De Faoite (AOCID) for linguistic review.

References

  1. 1.
    Adolfsson L, Lindau T, Arner M (2001) Acutrak screw fixation versus cast immobilisation for undisplaced scaphoid waist fractures. J Hand Surg [Br] 26:192–195Google Scholar
  2. 2.
    Amadio PC, Berquist TH, Smith DK, Ilstrup DM, Cooney WP 3rd, Linscheid RL (1989) Scaphoid malunion. J Hand Surg [Am] 14:679–687Google Scholar
  3. 3.
    Audigé L, Hanson B, Kopjar B (2006) Issues in the planning and conduct of non-randomised studies. Injury 37:340–348CrossRefPubMedGoogle Scholar
  4. 4.
    Bond CD, Shin AY, McBride MT, Dao KD (2001) Percutaneous screw fixation or cast immobilization for nondisplaced scaphoid fractures. J Bone Joint Surg Am 83-A:483–488PubMedGoogle Scholar
  5. 5.
    Brauer RB, Dierking M, Werber KD (1997) Die Anwendung der Herbert-Schraube mit der Freehand-Methode zur Osteosynthese der frischen Skaphoidfraktur. Unfallchirurg 100:776–781CrossRefPubMedGoogle Scholar
  6. 6.
    Compson JP, Waterman JK, Heatley FW (1997) The radiological anatomy of the scaphoid. Part 2: radiology. J Hand Surg [Br] 22:8–15Google Scholar
  7. 7.
    Desai VV, Davis TR, Barton NJ (1999) The prognostic value and reproducibility of the radiological features of the fractured scaphoid. J Hand Surg [Br] 24:586–590Google Scholar
  8. 8.
    Dias JJ (2001) Definition of union after acute fracture and surgery for fracture nonunion of the scaphoid. J Hand Surg [Br] 26:321–325Google Scholar
  9. 9.
    Dias JJ, Taylor M, Thompson J, Brenkel IJ, Gregg PJ (1988) Radiographic signs of union of scaphoid fractures. An analysis of inter-observer agreement and reproducibility. J Bone Joint Surg Br 70:299–301PubMedGoogle Scholar
  10. 10.
    Dias JJ, Wildin CJ, Bhowal B, Thompson JR (2005) Should acute scaphoid fractures be fixed? A randomized controlled trial. J Bone Joint Surg Am 87:2160–2168CrossRefPubMedGoogle Scholar
  11. 11.
    Du CL, Lai CF, Wang JD (2007) Delayed return-to-work in workers after non-severe occupational upper extremity fracture in Taiwan. J Formos Med Assoc 106:887–893CrossRefPubMedGoogle Scholar
  12. 12.
    Düppe H, Johnell O, Lundborg G, Karlsson M, Redlund-Johnell I (1994) Long-term results of fracture of the scaphoid. A follow-up study of more than thirty years. J Bone Joint Surg Am 76:249–252PubMedGoogle Scholar
  13. 13.
    Filan SL, Herbert TJ (1995) Avascular necrosis of the proximal scaphoid after fracture union. J Hand Surg [Br] 20:551–556Google Scholar
  14. 14.
    Frahm R, Lowka K, Vinee P (1992) Computertomographische Diagnostik bei Skaphoidfraktur und -pseudarthrose im Vergleich zur Rontgenaufnahme. Handchir Mikrochir Plast Chir 24:62–66PubMedGoogle Scholar
  15. 15.
    Haddad FS, Goddard NJ (1998) Acute percutaneous scaphoid fixation. A pilot study. J Bone Joint Surg Br 80:95–99CrossRefPubMedGoogle Scholar
  16. 16.
    Herbert TJ, Fisher WE (1984) Management of the fractured scaphoid using a new bone screw. J Bone Joint Surg Br 66:114–123PubMedGoogle Scholar
  17. 17.
    Hildebrandt VH, Bongers PM, van Dijk FJ, Kemper HC, Dul J (2001) Dutch musculoskeletal questionnaire: description and basic qualities. Ergonomics 44:1038–1055CrossRefPubMedGoogle Scholar
  18. 18.
    Hou WH, Tsauo JY, Lin CH, Liang HW, Du CL (2008) Worker’s compensation and return-to-work following orthopaedic injury to extremities. J Rehabil Med 40:440–445CrossRefPubMedGoogle Scholar
  19. 19.
    Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med 29:602–608CrossRefPubMedGoogle Scholar
  20. 20.
    Krimmer H, Schmitt R, Herbert T (2000) Kahnbeinfrakturen. Diagnostik, Klassifikation und Therapie. Unfallchirurg 103:812–819CrossRefPubMedGoogle Scholar
  21. 21.
    Lindström G, Nyström A (1990) Incidence of post-traumatic arthrosis after primary healing of scaphoid fractures: a clinical and radiological study. J Hand Surg [Br] 15:11–13Google Scholar
  22. 22.
    Mack GR, Wilckens JH, McPherson SA (1998) Subacute scaphoid fractures. A closer look at closed treatment. Am J Sports Med 26:56–58PubMedGoogle Scholar
  23. 23.
    MacKenzie EJ, Morris JA Jr, Jurkovich GJ, Yasui Y, Cushing BM, Burgess AR, DeLateur BJ, McAndrew MP, Swiontkowski MF (1998) Return to work following injury: the role of economic, social, and job-related factors. Am J Public Health 88:1630–1637CrossRefPubMedGoogle Scholar
  24. 24.
    McQueen MM, Gelbke MK, Wakefield A, Will EM, Gaebler C (2008) Percutaneous screw fixation versus conservative treatment for fractures of the waist of the scaphoid: a prospective randomised study. J Bone Joint Surg Br 90:66–71CrossRefPubMedGoogle Scholar
  25. 25.
    Modi CS, Nancoo T, Powers D, Ho K, Boer R, Turner SM (2009) Operative versus nonoperative treatment of acute undisplaced and minimally displaced scaphoid waist fractures—a systematic review. Injury 40:268–273CrossRefPubMedGoogle Scholar
  26. 26.
    Pfeiffer BM, Nübling M, Siebert HR, Schädel-Höpfner M (2006) A prospective multi-center cohort study of acute non-displaced fractures of the scaphoid: operative versus non-operative treatment [NCT00205985]. BMC Musculoskelet Disord 7:41CrossRefPubMedGoogle Scholar
  27. 27.
    Ram AN, Chung KC (2009) Evidence-based management of acute nondisplaced scaphoid waist fractures. J Hand Surg Am 34:735–738CrossRefPubMedGoogle Scholar
  28. 28.
    Rettig AC, Kollias SC (1996) Internal fixation of acute stable scaphoid fractures in the athlete. Am J Sports Med 24:182–186CrossRefPubMedGoogle Scholar
  29. 29.
    Saeden B, Tornkvist H, Ponzer S, Hoglund M (2001) Fracture of the carpal scaphoid. A prospective, randomised 12-year follow-up comparing operative and conservative treatment. J Bone Joint Surg Br 83:230–234CrossRefPubMedGoogle Scholar
  30. 30.
    Schädel-Höpfner M, Böhringer G, Gotzen L (2000) Die perkutane Osteosynthese der Skaphoidfraktur mit der Herbert-Whipple-Schraube—Technik und Resultate. Handchir Mikrochir Plast Chir 32:271–276CrossRefPubMedGoogle Scholar
  31. 31.
    Seland K, Cherry N, Beach J (2006) A study of factors influencing return to work after wrist or ankle fractures. Am J Ind Med 49:197–203CrossRefPubMedGoogle Scholar
  32. 32.
    Stecher WR (1937) Roentgenography of the carpal navicular bone. Am J Roentgenol 37:704–705Google Scholar
  33. 33.
    Trumble TE (1990) Avascular necrosis after scaphoid fracture: a correlation of magnetic resonance imaging and histology. J Hand Surg [Am] 15:557–564CrossRefGoogle Scholar
  34. 34.
    Trumble TE, Gilbert M, Murray LW, Smith J, Rafijah G, McCallister WV (2000) Displaced scaphoid fractures treated with open reduction and internal fixation with a cannulated screw. J Bone Joint Surg Am 82:633–641PubMedGoogle Scholar
  35. 35.
    Vinnars B, Pietreanu M, Bodestedt A, Ekenstam FA, Gerdin B (2008) Nonoperative compared with operative treatment of acute scaphoid fractures. A randomized clinical trial. J Bone Joint Surg Am 90-A:1176–1185CrossRefGoogle Scholar
  36. 36.
    Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483CrossRefPubMedGoogle Scholar
  37. 37.
    Wozasek GE, Moser KD (1991) Percutaneous screw fixation for fractures of the scaphoid. J Bone Joint Surg Br 73:138–142PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Michael Schädel-Höpfner
    • 1
    Email author
  • Marta Marent-Huber
    • 2
  • Emre Gazyakan
    • 3
  • Karin Tanzer
    • 4
  • Klaus D. Werber
    • 5
  • Hartmut R. Siebert
    • 6
  1. 1.Department of Trauma and Hand SurgeryUniversity HospitalDüsseldorfGermany
  2. 2.AO Clinical Investigation and DocumentationDübendorfSwitzerland
  3. 3.Department of Hand, Plastic, and Reconstructive Surgery, Burn Center, BG Trauma CentreUniversity of HeidelbergLudwigshafenGermany
  4. 4.Department for TraumatologyMedical University GrazGrazAustria
  5. 5.Department of Hand SurgeryMunich Technical University, Hospital rechts der IsarMünchenGermany
  6. 6.Department of Hand-, Plastic- and Trauma SurgeryDiakonie-Klinikum Schwäbisch HallSchwäbisch HallGermany

Personalised recommendations