Treatment of Scaphoid Fractures

Treatment of Scaphoid Fractures

Treatment of scaphoid fractures have evolved with time and it depends on type of fracture [Quick reference to classification of scaphoid fractures]

Treatment Options For Fractures of the Tubercle (Type A1)

These fractures represent an avulsion injury. Immobilization in cast for a period of four weeks is sufficient.

Undisplaced Scaphoid Fractures (Type A2)

Non Operative  Treatment

Undisplaced scaphoid fractures are usually stable. Immobilization in plaster cast is the preferred treatment. Xrays are taken at regular interval and surgery may be considered if the fracture displaces in follow up.

Most of the  stable scaphoid fractures unite in 6 to 8 weeks with cast immobilization but  can take 12 to 16 weeks or some even more.

By convention, the recommended cast is Scaphoid cast   but recent works have shown that Colles cast  is equally effective as well.

Operative Treatment

Many surgeons have repeatedly shown that fixation of undisplaced fractures gives significantly better results and a significantly lower rate of nonunion. It also means faster returns to work and can be considered depending on demands of the patient.

Unstable and Displaced Fractures (Type B2)

By definition, a scaphoid fracture is called displaced when

•  There is 1 mm of step-off
• > 60 degrees of scapholunate angulation
• >15 degrees of lunatocapitate angulation

Non Operative Treatment

Unstable fractures have a high incidence of delayed union and nonunion.  Most of these fractures would require surgical treatment

Conservative treatment should be considered in

• Metabolic diseases
• Poor compliance
• Medical comorbidities.
• Low functional demand

Non operative treatment includes closed reduction and immobilization.

Operative Treatment

Most of scphoid injuries occur in a young persons and require proper stabilization should be performed.

Percutaneus screw fixation after reduction of the fragments is  the preferred. Postoperative cast immobilization for 4 weeks is recommended in displaced fractures.

Proximal Pole Fractures (Type B3)

All proximal pole fractures of scaphoid should be treated operatively.

Other Fractures

Transscaphoid-perilunate fracture dislocation of carpus (Type B4),  Comminuted fractures (Type B5), Delayed union (Type C) should also be treated surgically.

Scaphoid non unions (type D) are discussed in separate article.