An Epidemiologic Perspective on Scaphoid Fracture Treatment and Frequency of Nonunion Surgery in the USA

Abstract

Background

Scaphoid fractures treated non-operatively and operatively may be complicated by nonunion.

Questions/Purposes

We sought to test the primary hypothesis that the incidence density of scaphoid fracture treatment is higher than previously estimated, to determine the frequency and risk factors for nonunion treatment, and to determine whether the frequency of surgical treatment increased over time.

Methods

The MarketScan® database was queried for all records of treatment (casting and surgery) for closed scaphoid fractures over a 6-year period. We examined subsequent claims to determine frequency of additional procedures for nonunion treatment (revision fixation or vascularized grafting occurring 28 days or more after initial treatment). Trend analyses were used to determine whether changes in frequency of surgical treatment or revision procedure occurred.

Results

The estimated incidence density of scaphoid fracture is 10.6 per 100,000 person-years in a commercially insured population of less than 65 years of age. Of 8923 closed scaphoid fractures, 29 and 71% were treated with surgery and casting, respectively. The frequency of surgical treatment rose significantly, from 22.1% in 2006 to 34.1% in 2012. The frequency of nonunion treatment was 10.8% after surgery and 3% after casting; neither changed over time. Younger age, male sex, and surgical treatment are associated with a higher risk of nonunion treatment.

Conclusions

Our estimated incidence of scaphoid fracture is higher than previously reported. The increased enthusiasm in the USA to surgically treat scaphoid fractures is reflected by our trend analysis. The frequency of surgical treatment for presumed nonunion after initial surgical management for closed scaphoid fractures exceeded 10%. Given the increased utilization of surgery, surgeons and patients should be aware of the frequency of nonunion treatment to inform treatment decisions.

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References

  1. 1.

    Beeres FJ, Hogervorst M, den Hollander P, Rhemrev S. Outcome of routine bone scintigraphy in suspected scaphoid fractures. Injury. 2005;36(10):1233–1236.

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Beeres FJ, Hogervorst M, Rhemrev SJ, den Hollander P, Jukema GN. A prospective comparison for suspected scaphoid fractures: bone scintigraphy versus clinical outcome. Injury. 2007;38(7):769–774.

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Beeres FJ, Rhemrev SJ, den Hollander P, et al. Early magnetic resonance imaging compared with bone scintigraphy in suspected scaphoid fractures. J Bone Joint Surg Br. 2008;90(9):1205–1209.

    Article  Google Scholar 

  4. 4.

    Buijze GA, Doornberg JN, Ham JS, et al. Surgical compared with conservative treatment for acute nondisplaced or minimally displaced scaphoid fractures: a systematic review and meta-analysis of randomized controlled trials. J Bone Joint Surg Am. 2010;92(6):1534–1544.

    Article  PubMed  Google Scholar 

  5. 5.

    Cahill KS, McCormick PC, Levi AD. A comprehensive assessment of the risk of bone morphogenetic protein use in spinal fusion surgery and postoperative cancer diagnosis. J Neurosurg Spine. 2015;10:1–8.

    Google Scholar 

  6. 6.

    Cole T, Veeravagu A, Zhang M, Ratliff JK. Surgeon procedure volume and complication rates in anterior cervical discectomy and fusions: analysis of a national longitudinal database. J Spinal Disord Tech. 2014; 30(5):E633–E639.

    Google Scholar 

  7. 7.

    Danielson E. White paper: health research data for the real world: the MarketScan® databases. Truven Health Analytics, Inc.; 2014. http://truvenhealth.com/Portals/0/Users/031/31/31/PH_13434%200314_MarketScan_WP_web.pdf.

  8. 8.

    Dias JJ, Brenkel IJ, Finlay DB. Patterns of union in fractures of the waist of the scaphoid. J Bone Joint Surg Br. 1989;71(2):307–310.

    Article  Google Scholar 

  9. 9.

    Duckworth AD, Jenkins PJ, Aitken SA, et al. Scaphoid fracture epidemiology. J Trauma Acute Care Surg. 2012;72(2):E41–45.

    Article  PubMed  Google Scholar 

  10. 10.

    Hasenboehler EA, Choudhry IK, Newman JT, et al. Bias towards publishing positive results in orthopedic and general surgery: a patient safety issue? Patient Saf Surg. 2007;1(1):4.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Huang KT, Hazzard M, Thomas S, et al. Differences in the outcomes of anterior versus posterior interbody fusion surgery of the lumbar spine: a propensity score-controlled cohort analysis of 10,941 patients. J Clin Neurosci. 2015;22(5):848–853.

    Article  PubMed  Google Scholar 

  12. 12.

    Ibrahim T, Qureshi A, Sutton AJ, Dias JJ. Surgical versus nonsurgical treatment of acute minimally displaced and undisplaced scaphoid waist fractures: pairwise and network meta-analyses of randomized controlled trials. J Hand Surg Am. 2011;36(11):1759–1768 e1751.

    Article  PubMed  Google Scholar 

  13. 13.

    Jonsson BY, Siggeirsdottir K, Mogensen B, Sigvaldason H, Sigursson G. Fracture rate in a population-based sample of men in Reykjavik. Acta Orthop Scand. 2004;75(2):195–200.

    Article  PubMed  Google Scholar 

  14. 14.

    Kastenberg ZJ, Hurley MP, Weiser TG, et al. Adding insult to injury: discontinuous insurance following spine trauma. J Bone Joint Surg Am. 2015;97(2):141–146.

    Article  PubMed  Google Scholar 

  15. 15.

    Larsen CF, Brondum V, Skov O. Epidemiology of scaphoid fractures in Odense, Denmark. Acta Orthop Scand. 1992;63(2):216–218.

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Miletic KG, Taylor TN, Martin ET, Vaidya R, Kaye KS. Readmissions after diagnosis of surgical site infection following knee and hip arthroplasty. Infect Control Hosp Epidemiol. 2014;35(2):152–157.

    Article  PubMed  Google Scholar 

  17. 17.

    Raittio LT, Jokihaara J, Huttunen TT, et al. Rising incidence of scaphoid fracture surgery in Finland. J Hand Surg Eur Vol. 2018;43(4):402–406. https://doi.org/10.1177/1753193417726051

  18. 18.

    Schuind F, Haentjens P, Van Innis F, et al. Prognostic factors in the treatment of carpal scaphoid nonunions. J Hand Surg Am. 1999;24(4):761–776.

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Suh N, Benson EC, Faber KJ, Macdermid J, Grewal R. Treatment of acute scaphoid fractures: a systematic review and meta-analysis. Hand (NY). 2010;5(4):345–353.

    Article  Google Scholar 

  20. 20.

    Trumble TE, Vo D. Proximal pole scaphoid fractures and nonunion. J Hand Surg Am. 2001;1(3):155–171.

    Article  Google Scholar 

  21. 21.

    Van Tassel DC, Owens BD, Wolf JM. Incidence estimates and demographics of scaphoid fracture in the US population. J Hand Surg Am. 2010;35(8):1242–1245.

    Article  PubMed  Google Scholar 

  22. 22.

    Yacub JN, Rice JB, Dillingham TR. Nerve injury in patients after hip and knee arthroplasties and knee arthroscopy. Am J Phys Med Rehabil. 2009;88(8):635–641.

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

In support of this study, the authors (DAO and NHK) received a $4,995 USD Institute of Clinical and Translational Sciences Just-In-Time Core Usage Grant from the Washington University in Saint Louis Center for Administrative Data Research.

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Correspondence to Nikolas H. Kazmers MD, MSE.

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Conflict of Interest

Christopher J. Dy, MD, MPH; Jack Baty, MS; and Kerry Bommarito, PhD, MPH, declare that they have no conflicts of interest. Nikolas H. Kazmers, MD, MSE, and Daniel A. Osei, MD, MSc, received a $4995 Institute of Clinical and Translational Sciences Just-In-Time Core Usage Grant from the Washington University in Saint Louis Center for Administrative Data Research in support of this work.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.

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Informed consent was waived from all patients for being included in this study.

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Dy, C.J., Kazmers, N.H., Baty, J. et al. An Epidemiologic Perspective on Scaphoid Fracture Treatment and Frequency of Nonunion Surgery in the USA. HSS Jrnl 14, 245–250 (2018). https://doi.org/10.1007/s11420-018-9619-3

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Keywords

  • casting
  • epidemiology
  • fracture
  • nonunion
  • scaphoid
  • surgery
  • treatment