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J Wrist Surg 2021; 10(03): 216-223
DOI: 10.1055/s-0040-1722333
Scientific Article

Comparison of Minimally Invasive Operative Treatment with Conservative Treatment for Acute, Minimally Displaced Scaphoid Fractures at 12 Months' Follow-up

Apostolos Fyllos 
1   Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, Biopolis, Larissa, Greece
,
George Komnos
1   Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, Biopolis, Larissa, Greece
,
Athanasios Koutis
1   Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, Biopolis, Larissa, Greece
,
Konstantinos Bargiotas
1   Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, Biopolis, Larissa, Greece
,
Sokratis Varitimidis
1   Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, Biopolis, Larissa, Greece
,
Zoe Dailiana 
1   Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, Biopolis, Larissa, Greece
2   Department of Hand, Upper Extremity and Microsurgery, IASO Thessalias, Nikaia, Larissa, Greece
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Abstract

Background Minimally displaced scaphoid fractures can be challenging to diagnose and treat. Cannulated scaphoid screws have made percutaneous stabilization highly effective.

Questions Would minimally invasive operative treatment of minimally displaced scaphoid fractures yield faster return to work when compared with patients treated conservatively? How do functional and patient satisfaction scores compare between the two groups at 12-months follow-up?

Patients and Methods Records from 18 patients (mean age 28.6 years) treated surgically were retrospectively reviewed and compared with a group of 10 patients (mean age 33.3 years, p = 0.74) treated nonoperatively. Inclusion criteria were a minimum follow-up period of 12 months and radiographic union. Time to return to work was compared between groups. At 12 months' follow-up, wrist range of motion (ROM) and grip strength were compared, as well as pain, satisfaction, and overall wrist function were evaluated by the visual analogue scale (VAS) and the Mayo modified wrist score (MMWS).

Results The mean time to return to work for the operated group was 39.75 days, while for the nonoperated group it was 88.14 days (p = 0.002). At the 12 months' follow-up, mean ROM, grip strength, and VAS score did not differ between groups. The mean MMWS was 98.75 for the operated group and 87.5 for the nonoperated group, indicating a better result in patients treated operatively (p = 0.03). In addition, two failures of instrumentation were recorded, a seldom seen complication.

Conclusion Percutaneous fixation of minimally displaced scaphoid fractures allows faster return to work and leaves patients more satisfied with their wrist function compared with plaster immobilization at 12 months' follow-up.

Level of evidence This is a Level III, retrospective, case–control study.

Keywords

scaphoid fracture - percutaneous fixation - nonoperative treatment - cannulated screws - cast treatment

Ethical Approval

Ethical board approval was granted for this retrospective research by our institution.


Note

This study was conducted at the Department of Orthopaedic Surgery of the University Hospital of Larissa.




Publication History

Received: 04 July 2020

Accepted: 12 November 2020

Article published online:
23 January 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Wolf JM, Dawson L, Mountcastle SB, Owens BD. The incidence of scaphoid fracture in a military population. Injury 2009; 40 (12) 1316-1319
    CrossrefPubMedSearch in Google Scholar
  • 2 Van Tassel DC, Owens BD, Wolf JM. Incidence estimates and demographics of scaphoid fracture in the U.S. population. J Hand Surg Am 2010; 35 (08) 1242-1245
    CrossrefPubMedSearch in Google Scholar
  • 3 Hove LM. Epidemiology of scaphoid fractures in Bergen, Norway. Scand J Plast Reconstr Surg Hand Surg 1999; 33 (04) 423-426
    CrossrefPubMedSearch in Google Scholar
  • 4 Barton NJ. The late consequences of scaphoid fractures. J Bone Joint Surg Br 2004; 86 (05) 626-630
    CrossrefPubMedSearch in Google Scholar
  • 5 Geurts G, van Riet R, Meermans G, Verstreken F. Incidence of scaphotrapezial arthritis following volar percutaneous fixation of nondisplaced scaphoid waist fractures using a transtrapezial approach. J Hand Surg Am 2011; 36 (11) 1753-1758
    CrossrefPubMedSearch in Google Scholar
  • 6 Iacobellis C, Baldan S, Aldegheri R. Percutaneous screw fixation for scaphoid fractures. Musculoskelet Surg 2011; 95 (03) 199-203
    CrossrefPubMedSearch in Google Scholar
  • 7 Moser VL, Krimmer H, Herbert TJ. Minimal invasive treatment for scaphoid fractures using the cannulated Herbert screw system. Tech Hand Up Extrem Surg 2003; 7 (04) 141-146
    CrossrefPubMedSearch in Google Scholar
  • 8 Meermans G, Verstreken F. Percutaneous transtrapezial fixation of acute scaphoid fractures. J Hand Surg Eur Vol 2008; 33 (06) 791-796
    CrossrefPubMedSearch in Google Scholar
  • 9 Patillo DP, Khazzam M, Robertson MW, Gainor BJ. Outcome of percutaneous screw fixation of scaphoid fractures. J Surg Orthop Adv 2010; 19 (02) 114-120
    PubMedSearch in Google Scholar
  • 10 Haddad FS, Goddard NJ. Acute percutaneous scaphoid fixation. A pilot study. J Bone Joint Surg Br 1998; 80 (01) 95-99
    CrossrefPubMedSearch in Google Scholar
  • 11 McQueen MM, Gelbke MK, Wakefield A, Will EM, Gaebler C. Percutaneous screw fixation versus conservative treatment for fractures of the waist of the scaphoid: a prospective randomised study. J Bone Joint Surg Br 2008; 90 (01) 66-71
    CrossrefPubMedSearch in Google Scholar
  • 12 Majeed H. Non-operative treatment versus percutaneous fixation for minimally displaced scaphoid waist fractures in high demand young manual workers. J Orthop Traumatol 2014; 15 (04) 239-244
    CrossrefPubMedSearch in Google Scholar
  • 13 Bushnell BD, McWilliams AD, Messer TM. Complications in dorsal percutaneous cannulated screw fixation of nondisplaced scaphoid waist fractures. J Hand Surg Am 2007; 32 (06) 827-833
    CrossrefPubMedSearch in Google Scholar
  • 14 Quadlbauer S, Beer T, Pezzei C. et al. Stabilization of scaphoid type B2 fractures with one or two headless compression screws. Arch Orthop Trauma Surg 2017; 137 (11) 1587-1595
    CrossrefPubMedSearch in Google Scholar
  • 15 Wheeler DL, McLoughlin SW. Biomechanical assessment of compression screws. Clin Orthop Relat Res 1998; (350) 237-245
    PubMedSearch in Google Scholar
  • 16 Toby EB, Butler TE, McCormack TJ, Jayaraman G. A comparison of fixation screws for the scaphoid during application of cyclical bending loads. J Bone Joint Surg Am 1997; 79 (08) 1190-1197
    CrossrefPubMedSearch in Google Scholar
  • 17 Assari S, Darvish K, Ilyas AM. Biomechanical analysis of second-generation headless compression screws. Injury 2012; 43 (07) 1159-1165
    CrossrefPubMedSearch in Google Scholar
  • 18 Gruszka D, Herr R, Hely H. et al. Impact of Different screw designs on durability of fracture fixation: in vitro study with cyclic loading of scaphoid bones. PLoS One 2016; 11 (01) e0145949
    CrossrefPubMedSearch in Google Scholar
  • 19 Erhart J, Unger E, Schefzig P. et al. Rotational stability of scaphoid osteosyntheses: an in vitro comparison of small fragment cannulated screws to novel bone screw sets. PLoS One 2016; 11 (06) e0156080
    CrossrefPubMedSearch in Google Scholar
  • 20 Jurkowitsch J, Dall'Ara E, Quadlbauer S. et al. Rotational stability in screw-fixed scaphoid fractures compared to plate-fixed scaphoid fractures. Arch Orthop Trauma Surg 2016; 136 (11) 1623-1628
    CrossrefPubMedSearch in Google Scholar
  • 21 Al-Ashhab ME, Elbegawi HEA. Percutaneous screw fixation for scaphoid fractures. Orthopedics 2017; 40 (04) e729-e734
    PubMedSearch in Google Scholar
  • 22 Bond CD, Shin AY, McBride MT, Dao KD. Percutaneous screw fixation or cast immobilization for nondisplaced scaphoid fractures. J Bone Joint Surg Am 2001; 83 (04) 483-488
    CrossrefPubMedSearch in Google Scholar
  • 23 Alnaeem H, Aldekhayel S, Kanevsky J, Neel OF. A systematic review and meta-analysis examining the differences between nonsurgical management and percutaneous fixation of minimally and nondisplaced scaphoid fractures. J Hand Surg Am 2016; 41 (12) 1135-1144.e1
    CrossrefPubMedSearch in Google Scholar
  • 24 Shen L, Tang J, Luo C, Xie X, An Z, Zhang C. Comparison of operative and non-operative treatment of acute undisplaced or minimally-displaced scaphoid fractures: a meta-analysis of randomized controlled trials. PLoS One 2015; 10 (05) e0125247
    CrossrefPubMedSearch in Google Scholar
  • 25 Ibrahim T, Qureshi A, Sutton AJ, Dias JJ. Surgical versus nonsurgical treatment of acute minimally displaced and undisplaced scaphoid waist fractures: pairwise and network meta-analyses of randomized controlled trials. J Hand Surg Am 2011; 36 (11) 1759-1768.e1
    CrossrefPubMedSearch in Google Scholar
  • 26 Al-Ajmi TA, Al-Faryan KH, Al-Kanaan NF. et al. A systematic review and meta-analysis of randomized controlled trials comparing surgical versus conservative treatments for acute undisplaced or minimally-displaced scaphoid fractures. Clin Orthop Surg 2018; 10 (01) 64-73
    CrossrefPubMedSearch in Google Scholar
  • 27 Dias JJ, Brealey SD, Fairhurst C. et al. Surgery versus cast immobilisation for adults with a bicortical fracture of the scaphoid waist (SWIFFT): a pragmatic, multicentre, open-label, randomised superiority trial. Lancet 2020; 396 (10248): 390-401
    CrossrefPubMedSearch in Google Scholar
  • 28 Arora R, Gschwentner M, Krappinger D, Lutz M, Blauth M, Gabl M. Fixation of nondisplaced scaphoid fractures: making treatment cost effective. Prospective controlled trial. Arch Orthop Trauma Surg 2007; 127 (01) 39-46
    CrossrefPubMedSearch in Google Scholar
  • 29 Papaloizos MY, Fusetti C, Christen T, Nagy L, Wasserfallen JB. Minimally invasive fixation versus conservative treatment of undisplaced scaphoid fractures: a cost-effectiveness study. J Hand Surg [Br] 2004; 29 (02) 116-119
    CrossrefPubMedSearch in Google Scholar
  • 30 Vinnars B, Ekenstam FA, Gerdin B. Comparison of direct and indirect costs of internal fixation and cast treatment in acute scaphoid fractures: a randomized trial involving 52 patients. Acta Orthop 2007; 78 (05) 672-679
    CrossrefPubMedSearch in Google Scholar