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Operative vs. konservative Therapie nichtdislozierter Skaphoidfrakturen

Ergebnisse einer kontrollierten multizentrischen Kohortenstudie

Operative versus conservative treatment of non-displaced fractures of the scaphoid bone

Results of a controlled multicenter cohort study

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An Erratum to this article was published on 09 February 2011

Zusammenfassung

Fragestellung

Im Rahmen einer prospektiven multizentrischen Kohortenstudie wurde die Frage untersucht, ob die operative Therapie von Skaphoidfrakturen zu einer früheren Rückkehr zum vorherigen Aktivitätsstatus führt.

Methodik

Eingeschlossen wurden nur isolierte, frische, komplette, stabile und nichtdislozierte Skaphoidfrakturen des mittleren Drittels. Rekrutiert wurden 94 Patienten mit derselben Anzahl von Frakturen. In der operativen Gruppe erfolgte eine Osteosynthese mit einer kanülierten Schraube und eine postoperative Schienenimmobilisation für maximal eine Woche. In der konservativen Gruppe wurde eine Ruhigstellung durch einen Unterarmcast bis zu Frakturheilung vorgenommen. Der Nachuntersuchungszeitraum betrug 6 Monate.

Ergebnisse

Bis zum Zeitpunkt von 15 Wochen fanden sich nach der operativen Therapie eine signifikant frühere Rückkehr zu Arbeit und häuslichen Aktivitäten sowie signifikant bessere Resultate für die Parameter funktioneller Status, Schmerz und Zufriedenheit. Jedoch wurden nach operativer Behandlung höhere Raten knöcherner Heilungsstörungen und sekundärer operativer Maßnahmen registriert.

Schlussfolgerung

Die operative Behandlung führt zu einer früheren Rückkehr zur vorherigen Aktivität und zu einem besseren funktionellen Status, weniger Schmerzen und einer höheren Patientenzufriedenheit. Andererseits scheint die konservative Therapie sicherer und mit einer geringeren Komplikationsrate assoziiert zu sein.

Abstract

Purpose

Within a prospective, multicenter cohort study we investigated whether operative treatment of scaphoid bone fractures leads to earlier return to previous activity levels.

Methods

Only isolated, acute, complete, stable and non-displaced fractures of the mid-third of the scaphoid bone were included. A total of 94 patients with the same number of fractures were recruited. In the operative group, fractures were fixed with a cannulated screw and had postoperative splint immobilization for a maximum of 1 week. In the conservative group a short arm cast was applied until fracture union was achieved. Both groups were followed for 6 months.

Results

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

Conclusion

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

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Literatur

  1. Adolfsson L, Lindau T, Arner M (2001) Acutrak screw fixation versus cast immobilisation for undisplaced scaphoid waist fractures. J Hand Surg [Br] 26:192–195

    Google Scholar 

  2. Amadio PC, Berquist TH, Smith DK et al (1989) Scaphoid malunion. J Hand Surg [Am] 14:679–687

    Google Scholar 

  3. Audigé L, Hanson B, Kopjar B (2006) Issues in the planning and conduct of non-randomised studies. Injury 37:340–348

    Article  PubMed  Google Scholar 

  4. Betsch M, Jungbluth P, Hakimi M et al (2010) Die primär nicht nachweisbare Skaphoidfraktur – Eine diagnostische Herausforderung? Handchir Mikrochir Plast Chir 42:71–74

    Article  CAS  PubMed  Google Scholar 

  5. 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:483–488

    Google Scholar 

  6. Brauer RB, Dierking M, Werber KD (1997) Die Anwendung der Herbert-Schraube mit der Freehand-Methode zur Osteosynthese der frischen Skaphoidfraktur. Unfallchirurg 100:776–781

    Article  CAS  PubMed  Google Scholar 

  7. Compson JP, Waterman JK, Heatley FW (1997) The radiological anatomy of the scaphoid. Part 2: Radiology. J Hand Surg [Br] 22:8–15

    Google Scholar 

  8. Desai VV, Davis TR, Barton NJ (1999) The prognostic value and reproducibility of the radiological features of the fractured scaphoid. J Hand Surg [Br] 24:586–590

    Google Scholar 

  9. Dias JJ (2001) Definition of union after acute fracture and surgery for fracture nonunion of the scaphoid. J Hand Surg [Br] 26:321–325

    Google Scholar 

  10. Dias JJ, Taylor M, Thompson J et al (1988) Radiographic signs of union of scaphoid fractures. An analysis of inter-observer agreement and reproducibility. J Bone Joint Surg [Br] 70:299–301

    Google Scholar 

  11. Dias JJ, Wildin CJ, Bhowal B, Thompson JR (2005) Should acute scaphoid fractures be fixed? A randomized controlled trial. J Bone Joint Surg [Am] 87:2160–2168

    Google Scholar 

  12. 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 106:887–893

    Article  PubMed  Google Scholar 

  13. Düppe H, Johnell O, Lundborg G et al (1994) Long-term results of fracture of the scaphoid. A follow-up study of more than thirty years. J Bone Joint Surg [Am] 76:249–252

    Google Scholar 

  14. Filan SL, Herbert TJ (1995) Avascular necrosis of the proximal scaphoid after fracture union. J Hand Surg [Br] 20:551–556

    Google Scholar 

  15. Frahm R, Lowka K, Vinee P (1992) Computertomographische Diagnostik bei Skaphoidfraktur und -pseudarthrose im Vergleich zur Rontgenaufnahme. Handchir Mikrochir Plast Chir 24:62–66

    CAS  PubMed  Google Scholar 

  16. Haddad FS, Goddard NJ (1998) Acute percutaneous scaphoid fixation. A pilot study. J Bone Joint Surg [Br] 80:95–99

    Google Scholar 

  17. Herbert TJ, Fisher WE (1984) Management of the fractured scaphoid using a new bone screw. J Bone Joint Surg [Br] 66:114–123

    Google Scholar 

  18. Hildebrandt VH, Bongers PM, Dijk FJ van et al (2001) Dutch Musculoskeletal Questionnaire: description and basic qualities. Ergonomics 44:1038–1055

    Article  CAS  PubMed  Google Scholar 

  19. Hou WH, Tsauo JY, Lin CH et al (2008) Worker’s compensation and return-to-work following orthopaedic injury to extremities. J Rehabil Med 40:440–445

    Article  PubMed  Google Scholar 

  20. 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 29:602–608

    Article  CAS  PubMed  Google Scholar 

  21. Krimmer H, Schmitt R, Herbert T (2000) Kahnbeinfrakturen. Diagnostik, Klassifikation und Therapie. Unfallchirurg 103:812–819

    Article  CAS  PubMed  Google Scholar 

  22. 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] 15:11–13

    Google Scholar 

  23. Mack GR, Wilckens JH, McPherson SA (1998) Subacute scaphoid fractures. A closer look at closed treatment. Am J Sports Med 26:56–58

    CAS  PubMed  Google Scholar 

  24. MacKenzie EJ, Morris JA Jr, Jurkovich GJ et al (1998) Return to work following injury: the role of economic, social and job-related factors. Am J Public Health 88:1630–1637

    Article  CAS  PubMed  Google Scholar 

  25. McQueen MM, Gelbke MK, Wakefield A et al (2008) Percutaneous screw fixation versus conservative treatment for fractures of the waist of the scaphoid: a prospective randomised study. J Bone Joint Surg [Br] 90:66–71

    Google Scholar 

  26. Modi CS, Nancoo T, Powers D et al (2009) Operative versus nonoperative treatment of acute undisplaced and minimally displaced scaphoid waist fractures – a systematic review. Injury 40:268–273

    Article  PubMed  Google Scholar 

  27. 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 7:41

    Article  PubMed  Google Scholar 

  28. Ram AN, Chung KC (2009) Evidence-based management of acute nondisplaced scaphoid waist fractures. J Hand Surg [Am] 34:735–738

    Google Scholar 

  29. Rettig AC, Kollias SC (1996) Internal fixation of acute stable scaphoid fractures in the athlete. Am J Sports Med 24:182–186

    Article  CAS  PubMed  Google Scholar 

  30. 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] 83:230–234

    Google Scholar 

  31. 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 32:271–276

    Article  PubMed  Google Scholar 

  32. Seland K, Cherry N, Beach J (2006) A study of factors influencing return to work after wrist or ankle fractures. Am J Ind Med 49:197–203

    Article  PubMed  Google Scholar 

  33. Stecher WR (1937) Roentgenography of the carpal navicular bone. Am J Roentgenol 37:704–705

    Google Scholar 

  34. Trumble TE (1990) Avascular necrosis after scaphoid fracture: a correlation of magnetic resonance imaging and histology. J Hand Surg [Am] 15:557–564

    Google Scholar 

  35. Trumble TE, Gilbert M, Murray LW et al (2000) Displaced scaphoid fractures treated with open reduction and internal fixation with a cannulated screw. J Bone Joint Surg [Am] 82:633–641

    Google Scholar 

  36. Vinnars B, Pietreanu M, Bodestedt A et al (2008) Nonoperative compared with operative treatment of acute scaphoid fractures. A Randomized Clinical Trial. J Bone Joint Surg [Am] 90-A:1176–1185

  37. Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483

    Article  PubMed  Google Scholar 

  38. Wozasek GE, Moser KD (1991) Percutaneous screw fixation for fractures of the scaphoid. J Bone Joint Surg [Br] 73:138–142

    Google Scholar 

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Danksagung

Die Autoren danken allen teilnehmenden Zentren und den nachfolgenden Studienverantwortlichen, sofern nicht als Koautoren dieser Publikation genannt, für ihre engagierte Mitarbeit an dieser Studie: K.H. Winker (Erfurt), G. Böhringer (Gießen), F.J. Seibert (Graz), J.M. Rueger (Hamburg), H. Towfigh (Hamm), E. Gazyakan (Ludwigshafen), R. Arora (Innsbruck), E. Brück (Marburg), K.D. Werber (München), R. Slodicka (Rosenheim).

Weiterhin möchten sich die Autoren bei L. Audigé (AOCID) für die statistische Beratung und D. Witschi (AOCID) für die Betreuung bei dieser Studie bedanken.

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Authors and Affiliations

  1. Klinik für Unfall- und Handchirurgie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland

    M. Schädel-Höpfner

  2. AO Clinical Investigation and Documentation, Dübendorf, Schweiz

    M. Marent-Huber

  3. Klinik für Plastische, Hand- und Rekonstruktive Chirurgie, Kliniken des Main-Taunus-Kreises Bad Soden a.T., Bad Soden, Deutschland

    M. Sauerbier

  4. Klinik für Handchirurgie, Rhön-Klinikum Bad Neustadt, Bad Neustadt, Deutschland

    T. Pillukat

  5. Abteilung für Hand-, Replantations- und Mikrochirurgie, Unfallkrankenhaus Berlin, Berlin, Deutschland

    A. Eisenschenk

  6. Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Diakonie-Klinikum SchwäbischHall, SchwäbischHall, Deutschland

    H.R. Siebert

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  1. M. Schädel-Höpfner
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  3. M. Sauerbier
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  6. H.R. Siebert
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Corresponding author

Correspondence to M. Schädel-Höpfner.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s00113-011-1985-y

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Schädel-Höpfner, M., Marent-Huber, M., Sauerbier, M. et al. Operative vs. konservative Therapie nichtdislozierter Skaphoidfrakturen. Unfallchirurg 113, 804–813 (2010). https://doi.org/10.1007/s00113-010-1848-y

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