Résumé
Les fractures du scaphoïde carpien sont fréquentes, mais leur prise en charge thérapeutique reste difficile du fait de la géométrie particulière de cet os et de la précarité de sa vascularisation. Un retard diagnostique initial et des erreurs de prise en charge peuvent conduire à une pseudarthrose, source de désaxation intracarpienne secondaire menant inexorablement à la dégénérescence arthrosique du poignet. Les progrès dans le dépistage radiologique, le développement de techniques chirurgicales mini-invasives et de matériels de synthèse spécifiques ont conduit à une attitude plus résolument chirurgicale, y compris dans les fractures non déplacées relevant classiquement du traitement orthopédique. L’arthroscopie de poignet constitue, dans notre expérience, un apport indéniable dans la prise en charge de ces fractures, non seulement du fait de la possibilité de contrôler la qualité de réduction de ces fractures articulaires, mais également pour ne pas méconnaître les lésions ostéochondrales ou ligamentaires associées.
Abstract
Scaphoid fractures are common but present unique challenges because of the particular geometry of the bone and the tenuous vascular pattern of the scaphoid. Delays in diagnosis and inadequate treatment for acute scaphoid fractures may lead to non-unions that can progress to carpal collapse and degenerative arthritis of the wrist. Improvements in diagnosis, surgical treatment and implant materials have encouraged a trend toward early internal fixation even for non-displaced scaphoid fractures that could potentially be treated non-operatively. In our experience wrist arthroscopy is a useful tool in the management of these fractures not only for assessing the quality of reduction but also for visualizing osteochondral and ligamentous injuries associated with intra-articular fractures.
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Martinache, X. Traitement des fractures récentes du scaphoïde carpien. Lett Med Phys Readapt 25, 32–38 (2009). https://doi.org/10.1007/s11659-009-0125-3
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DOI: https://doi.org/10.1007/s11659-009-0125-3