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Long-term outcome following early percutaneous screw fixation of acute scaphoid fractures

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Project log

Chris Oliver
added a research item
Invited Gold Medal lecture. "How not to be a surgeon!" Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, UK. Closed virtual event. 2021. The pdf file is only pictures. The original presentation has sound and video, the file is too big for ResearchGate, contact me for a DropBox Link.
Ryan D Broll
added 2 research items
Early percutaneous screw fixation is increasingly used to manage acute scaphoid fractures as it provides a quicker return to work and sports, but little is known about the long-term subjective outcomes following surgery. The aim of this study was to report the long-term outcomes and complication rates following early percutaneous fixation of acute fractures of the scaphoid. A prospective trauma database was searched to identify all skeletally-mature patients with scaphoid fractures managed with early percutaneous fixation over a thirteen-year period from 1997-2010. Medical records were retrospectively reviewed, and complications documented. Long-term follow-up was by a questionnaire-based telephone review: The Patient-Reported Wrist Evaluation (PRWE) was the primary outcome measure. Secondary outcomes included subjective ratings of pain, stiffness and satisfaction, the Quick Disability of the Arm, Shoulder and Hand (QuickDASH) score, and the EQ-5D-5L questionnaire as a standardized measure of general health status. Patients managed with early percutaneous fixation of acute scaphoid fractures report excellent long-term subjective outcomes with minimal persistent pain, low complication rates and high satisfaction. The long-term outcomes are comparable to other management approaches but offer a quicker return to work and sport. Patients who developed complications reported poorer long-term outcomes, therefore future research should aim to determine predictors of complication in patients selected for early percutaneous fixation. Recent meta-analyses have highlighted the need for sufficiently-powered, multicenter RCTs directly comparing early percutaneous fixation and conservative management. The results of the UK SWIFFT trial are awaited.
Hypothesis: Early percutaneous screw fixation is increasingly used to manage acute scaphoid fractures as it provides a quicker return to work and sports, but little is known about the long-term subjective outcomes following surgery. The aim of this study was to report the long-term outcomes and complication rates following early percutaneous fixation of acute fractures of the scaphoid. Methods: A prospective trauma database was searched to identify all skeletally-mature patients with scaphoid fractures managed with early percutaneous fixation over a thirteen-year period from 1997-2010. Medical records were retrospectively reviewed and complications documented. Long-term follow-up was by a questionnaire based telephone review. The Patient-Reported Wrist Evaluation (PRWE) was the primary outcome measure. Secondary outcomes included subjective ratings of pain, stiffness and satisfaction, the Quick Disability of the Arm, Shoulder and Hand (QuickDASH) instrument, and the EuroQol EQ-5D-5L questionnaire as a standardised measure of general health status. Results: 116 patients (88% male) with a mean age of 28.5 years (range, 15-62) at time of injury were identified. Thirteen patients (11%) had an identified complication during their recovery, with twelve patients requiring further surgical intervention. Six patients developed a non-union, with 3 patients having persistent non-union despite further with ORIF and bone grafting. Six patients had a prominent symptomatic screw that was either subsequently removed or one that underwent early revision. There was an association between mechanism of injury and development of a complication (p=0.007), with higher than expected rates of falls from height in the complication group. At a mean follow-up of 9.9 years (range, 6.4-19.0; n=50 currently), six patients (12%) reported persistent pain in their wrist with a mean VAS score of 0.6/10. Stiffness was more prevalent at 24%. Ninety-six percent of patients were satisfied with their wrist, with a median satisfaction rating of 10/10 (completely satisfied). The mean PRWE score was 7.4 ±14.6 (range, 0.0-84.5) and mean QuickDASH score was 3.6 ±7.8 (range, 0.0-45.0). The median EQ-5D-5L impairment index value was 1.000 (no impairment), and the mean self-perceived global health rating (EQ-VAS) was 82/100. Summary Points:  Patients managed with early percutaneous fixation of acute scaphoid fractures report excellent long-term subjective outcomes with minimal persistent pain, low complication rates and high satisfaction  The long-term outcomes are comparable to other management approaches but offer a quicker return to work and sport. Was selected as top 5 poster at the ASSH meeting