Abstract
Introduction
Nondisplaced scaphoid waist fractures treated with prolonged plaster immobilisation often lead in transient joint stiffness and to a delay in return to sport and work activity. The long time off work increases the work off compensation costs. Internal fixation of scaphoid fractures has resulted in a shorter time to union and to return to work and sports. This prospective study compares cast immobilisation with screw fixation and the direct cost with indirect cost of conservative and minimally invasive treatment of undisplaced scaphoid fractures.
Materials and methods
Forty-seven patients with an acute nondisplaced waist fracture of the scaphoid were allocated into either cast immobilisation or internal screw fixation for this study. Cost data concerning the groups of nonoperated and operated patients were analysed. Range of wrist motion, grip strength, DASH-score, time to fracture union, return to work time and the needed physiotherapy at the final follow-up at 6 months were evaluated.
Results
Twenty-one patients were included in the group of screw fixation and 23 patients were included in the group of cast immobilisation. At final follow-up there was no significant difference in the range of motion of the wrist or in grip strength. The operatively treated group had a better mean DASH-score than the conservative group. Fracture union was seen in the screw fixation group at a mean of 43 days and in the cast immobilisation group at a mean of 74 days (P < 0.5). The average time of return to work was 8 days for patients who had an internal screw fixation, while those treated with a cast returned to work at a mean of 55 days (P < 0.5). In total the internal fixation of undisplaced scaphoid fractures is less expensive than conservative treatment.
Conclusion
Internal screw fixation of nondisplaced scaphoid fractures had a shorter time to bony union and the patients returned earlier to work compared with cast immobilisation. Although it is assumed that operative treatment is more expensive, in this study the cost was not found to be higher.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Adolfsson L, Lindau T, Arner M (2001) Acutrak screw fixation versus cast immobilisation for undisplaced scaphoid waist fractures. J Hand Surg 26B:192–195
Bond CD, Shin AY, McBride MT, Dao KD (2001) Percutaneous screw fixation or cast immobilization for nondisplaced scaphoid fractures. J Bone Joint Surg 83A:483–488
Borgeskov S, Christiansen B, Kjaer A, Balslev I (1966) Fractures of the carpal bones. Acta Ortopaedica Scand 37:276–287
Cooney WP, Dobyns JH, Linscheid RL (1980) Fractures of the scaphoid: a rational approach to management. Clin Orthop Related Res 149:90–97
Dias JJ, Brenkel IJ, Finlay DB (1989). Patterns of union in fractures of the waist of the scaphoid. J Bone Joint Surg 71B:307–310
Dias JJ, Wildin CJ, Bhowal B, Thompson JR (2005) Should acute scaphoid fractures be fixed? J Bone Joint Surg 87A:2160–2168
Desai W, Davis TR, Barton NJ (1999) The prognostic value and reproducibility of the radiological features of the fractured scaphoid. J Hand Surg 24B:586–590
Eddeland A, Eiken O, Hellgren E, Ohlsson NM (1975) Fractures of the scaphoid. Scand J Plast Reconstr Surg 9:234–239
Haddad FS, Goddard NJ (1998). Acute percutaneous scaphoid fixation. A pilot study. J Bone Joint Surg 80B:95–99
Herbert TJ, Fisher WE (1984). Management of the fractured scaphoid using a new bone screw. J Bone Joint Surg 66B:114–123
Hove LM (1999). Epidemiology of scaphoid fractures in Bergen, Norway. Scand J Plast Reconstr Surg Hand Surg 33:423–426
Inoue G, Shionoya K (1997). Herbert screw fixation by limited access for acute fractures of the scaphoid. J Bone Joint Surg 79B:418–421
Kuschner SH, Lane CS, Brien WW, Gellmann H (1994). Scaphoid fractures and scaphoid nonunion. Diagnosis and treatment. Orthop Rev 23:861–871
MacDermid JC (1996) Development of a scale for patient rating of wrist pain and disability. J Hand Ther 9:178–83
Mack GR, Bosse MJ, Gelbermann RH (1984) The natural history of scaphoid non-union. J Bone Joint Surg 66A:504–509
O’Brien L, Herbert T (1985) Internal fixation of acute scaphoid fractures: a new approach to treatment. Aust N Z J Surg 55:387–389
Papaloizos MY, Fusetti C, Christen T, Nagy L, Wassefallen JB (2004). Minimally invasive fixation versus conservative treatment of undisplaced scaphoid fractures: a cost-effectiveness study. J Hand Surg 29B:116–119
Rajagopalan BM, Squire DS, Samuels LO (1999) Results of Herbert screw fixation with bone-grafting for the treatment of nonunion of the scaphoid. J Bone Joint Surg 81A:48–52
Rettig AC, Kollias SC (1996) Internal fixation of acute stable scaphoid fractures in the athlete. Am J Sports Med 2:182–186
Rettig ME, Raskin KB (1999) Retrogade compression screw fixating of acute proximal pole scaphoid fractures. J Hand Surg 24A:1206–1210
Rettig ME, Kozin SH, Cooney WP (2001) Open reduction and internal fixation of acute displaced scaphoid waist fractures. J Hand Surg 26A:271–276
Russe O (1960) Fracture of the carpal navicular. Diagnosis, non-operative treatment, and operative treatment. J Bone J Surg 42A:759–768
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 83B:230–234
Acknowledgments
We are grateful to Ms. Mariette Widner for assistance collecting the cost data.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Arora, R., Gschwentner, M., Krappinger, D. et al. Fixation of nondisplaced scaphoid fractures: making treatment cost effective. Arch Orthop Trauma Surg 127, 39–46 (2007). https://doi.org/10.1007/s00402-006-0229-z
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-006-0229-z