This article is more than 5 years old. Information may no longer be current.
Comparable results achieved with operative, nonoperative treatment of scaphoid fractures
Click Here to Manage Email Alerts
An instructional lecture at this year’s congress will evaluate the treatment of scaphoid fractures, which account for 60% of carpal fractures, according to the abstract.
The lecture will be presented by Prof. Joe Dias, FRCS, MD, of University Hospitals of Leicester N.H.S. Trust in the U.K., and will cover such topics as classification, diagnosis and outcomes following nonoperative and operative treatments of undisplaced and displaced scaphoid fractures.
Dias told Orthopaedics Today Europe that the current trend in treatment is toward internal fixation of all acute schaphoid fractures. “The single thing that I want attendees to go away with is the message that the benefits of surgical fixation are unproven, that it is at present a preference rather than a superior method … I want my colleagues to start thinking about why they are operating on these young patients.”
The lecture will include a review of published clinical trials comparing casting with surgery in acute scaphoid fractures, from which Dias has concluded that the rate of bony union for both methods is greater than 90%.
According to the written version of his lecture that will be published in EFORT’s European Instructional Lectures 2011, Dias treats most scaphoid fracture patients with a below-elbow plaster cast with the thumb free for 6 to 8 weeks, but considers surgery for displaced fractures causing dorsal intercalated segment instability, proximal pole fractures, fractures associated with perilunate injuries, open fractures and fractures in multiply-injured patients.
“Other decision-making factors are whether there is a great potential for morbidity from prolonged immobilization, the occupation of the patient, and a clear failure of healing after nonoperative treatment of the fracture,” he wrote. – by Thomas M. Springer
References:
- Dias JJ. Instructional lecture: scaphoid fractures. To be presented at the 2011 EFORT Congress. June 1-4, 2011. Copenhagen.
- Dias JJ. Scaphoid fractures. In: Bentley G, ed. European Instructional Lectures 2011. EFORT; 2011.
- Prof. Joe Dias, FRCS, MD, can be reached at the University Hospitals of Leicester N.H.S. Trust, Leicester, United Kingdom; + 0116-256-3089; e-mail: joseph.dias@uhl-tr.nhs.uk.
- Disclosure: Dias has no relevant financial disclosures.
Scaphoid fractures must be diagnosed early to then immobilize and stabilize the fracture as soon as possible. This can influence positively the outcome to avoid a high potential of nonunion or bone necrosis. A scaphoid fracture must be suspected in all wrist traumas and treated until the fracture can be denied. The use of a standardized treatment algorithm may make it possible to select the patients for appropriate treatment. The treatment should be discussed with the patient and chosen in accordance to the fracture type, localization and displacement. Not all scaphoid fractures have to be operated. Good results can be reached with cast immobilization. Arthroscopic procedures are important in the treatment of this injury but cannot solve all problems. Bone graft, including vascularized bone grafts, are often needed for the treatment of the difficult cases.
— Philippe Kopylov, MD, PhD
Hand Surgery
Malmö Lund
Lunds University Hospital, Sweden
Disclosure: He
has no relevant financial disclosures.