Clinical and radiological outcome of cast immobilisation versus surgical treatment of acute scaphoid fractures at a mean follow-up of 93 months

Department of Orthopaedic Surgery, University Hospitals of Leicester NHS Trust, Groby Road, Leicester, LE3 9QP, UK.
The Bone & Joint Journal (Impact Factor: 2.8). 07/2008; 90(7):899-905. DOI: 10.1302/0301-620X.90B7.20371
Source: PubMed

ABSTRACT We report the outcome at a mean of 93 months (73 to 110) of 71 patients with an acute fracture of the scaphoid who were randomised to Herbert screw fixation (35) or below-elbow plaster cast immobilisation (36). These 71 patients represent the majority of a randomised series of 88 patients whose short-term outcome has previously been reported. Those patients available for later review were similar in age, gender and hand dominance. There was no statistical difference in symptoms and disability as assessed by the mean Patient Evaluation Measure (p = 0.4), or mean Patient-Rated Wrist Evaluation (p = 0.9), the mean range of movement of the wrist (p = 0.4), mean grip strength (p = 0.8), or mean pinch strength (p = 0.4). Radiographs were available from the final review for 59 patients. Osteoarthritic changes were seen in the scaphotrapezial and radioscaphoid joints in eight (13.5%) and six patients (10.2%), respectively. Three patients had asymptomatic lucency surrounding the screw. One non-operatively treated patient developed nonunion with avascular necrosis. In five patients who were treated non-operatively (16%) there was an abnormal scapholunate angle ( > 60 degrees ), but in four of these patients this finding was asymptomatic. No medium-term difference in function or radiological outcome was identified between the two treatment groups.

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    ABSTRACT: Despite extensive literature supporting the use of computerized tomography (CT) scans in evaluating scaphoid fractures, there has not been a consensus on the methodology for defining and quantifying union. The purpose of this study was to test the inter-observer reliability of two methods of quantifying scaphoid union. The CT scans of 50 non-operatively treated scaphoid fractures were reviewed by four blinded observers. Each was asked to classify union into one of three categories, united, partially united, or tenuously united, based on their general impression. Each reviewer then carefully analyzed each CT slice and quantified union based on two methods, the mean percentage union and the weighted mean percentage union. The estimated percentage of scaphoid union for each scan was recorded, and inter-observer reliability for both methods was assessed using a Bland-Altman plot to calculate the 95% limits of agreement. Kappa statistic was used to measure the degree of agreement for the categorical assessment of union. There was very little difference in the percentage of union calculated between the two methods (mean difference between the two methods was 1.2 +/- 4.1%), with each reviewer demonstrating excellent agreement between the two methods based on the Bland-Altman plot. The kappa score indicated very good agreement ([latin capital letter k with hook] = 0.80) between the consultant hand surgeon and the musculoskeletal radiologist, and good agreement ([latin capital letter k with hook] = 0.62) between the consultant hand surgeon and the hand fellow for the categorical assessment of union. This study describes two methods of quantifying and defining scaphoid union, both with a high inter-rater reliability. This indicates that either method can be reliably used, making it an important tool for both for clinical use and research purposes in future studies of scaphoid fractures, particularly those which are using union or time to union as their endpoint.Level of evidence: Diagnostic, level III.
    Journal of Orthopaedic Surgery and Research 08/2013; 8(1):28. DOI:10.1186/1749-799X-8-28 · 1.58 Impact Factor
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    ABSTRACT: The aim of this review was to present currently available evidence on the management of acute scaphoid fractures. Acute scaphoid fractures are usually diagnosed by a combination of history, physical examination, and radiography. However, in many patients scaphoid fractures are still missed. Thus, the general trend is to over-treat patients with a suspicion of scaphoid fracture. Many aspects of scaphoid fracture management are still controversial and different institutions vary in their approach.
    Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine 12/2013; DOI:10.12809/hkmj134146
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    ABSTRACT: Zusammenfassung Hintergrund Im Rahmen einer retrospektiven Nachuntersuchung sollen die Behandlungsergebnisse von 208 Kahnbeinpseudarthrosen dargestellt und mit der aktuellen Literatur verglichen werden. Material und Methode Im Rahmen einer retrospektiven Fall-Kontroll-Studie wurden zwischen 2000 und 2006 insgesamt 208 Patienten mit operativ versorgter Kahnbeinpseudarthrose radiologisch nachuntersucht. Die Unterteilung der Patienten erfolgte nach der Lokalisation der Kahnbeinpseudarthrose: distales Drittel (n=10), mittleres Drittel (n=105) und proximales Drittel (n=93). Bei Vorliegen eines avaskulären proximalen Pols sowie bei Rezidivpseudarthrosen erfolgte als additives operatives Verfahren zusätzlich zur Pseudarthrosenresektion und Beckenkammspaninterposition die Interposition oder Apposition eines vaskularisierten Radiusspans (n=53). Die Auswertung erfolgte konventionell radiologisch, ggf. durch eine CT-Untersuchung. Ergebnisse Eine knöcherne Konsolidierung zeigte sich bei insgesamt 187 Patienten (89,9%). Betraf die Kahnbeinpseudarthrose das proximale Drittel (n=93), konnte bei insgesamt 83% (n=77) der Patienten eine Ausheilung erreicht werden. Bei den Patienten mit vaskularisiertem Radiusspan (n=53) zeigte sich auch bei Vorliegen eines avaskulären proximalen Pols oder einer Rezidivpseudarthrose eine Durchbauung von 81%. Schlussfolgerung Die Prognose der Konsolidierung einer Kahnbeinpseudarthrose unter Anwendung differenzierter Operationsverfahren wie z. B. des vaskularisierten Radiusspans ist sehr gut.
    Der Unfallchirurg 11/2011; 115(11). DOI:10.1007/s00113-011-1956-3 · 0.61 Impact Factor

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