OTA 2002 Posters
Percutaneous Screw Fixation versus Nonoperative Treatment in Undisplaced Scaphoid Fractures
Christian Gaebler, MD1, Margaret M. McQueen, MD, FRCS2,Vilmos Vécsei, MD1,1University of Vienna Medical School, Department of Traumatology, Vienna, Austria; and 2Royal Infirmary of Edinburgh NHS Trust, Edinburgh, United Kingdom
Purpose: Our hypothesis was that patients with percutaneous screw fixation of undisplaced scaphoid fractures about the wrist might show earlier recovery, go back to sports earlier, show a better range of motion, and a lower rate of nonunions compared with patients treated nonoperatively.
Methods: Fifty-eight patients with undisplaced scaphoid fractures were prospectively randomized into two groups: 28 operative and 30 nonoperative. Follow-up examinations were at 8, 12, 16, 26, and 52 weeks after trauma and included radiologic examinations, evaluation of grip strength, pinch grip, time to return to work and sports, range of motion, and Green/O'Brian score.
Results: In the operative group, there was one deep wound infection (3.6%) and three broken screwdrivers. There were no nonunions and a high rate of patient satisfaction. In the nonoperative group, there were five nonunions (16.7%) and two cases of reflex sympathetic dystrophy. The results showed that the operative group was significantly better (P < 0.0001) in all respects (Green/O'Brian score, range of motion, grip strength, pinch grip) at week 8 and week 12. The operative group was still obviously better at week 26, but this was not significant. Patients who were operated on were significantly (P < 0.05) earlier back at work (5 weeks compared with 7.8 weeks) and significantly (P < 0.0001) earlier back to active sports (5.6 weeks compared with 14.1 weeks).
Discussion: The results of this study suggest that percutaneous stabilization of scaphoid fractures is a safe and reasonable approach, especially in younger patients who want and need to get back to work and sports early. There was a13.6% rate of nonunions in the nonoperative group, whereas all fractures in the operative group united.
Conclusion: Percutaneous screw fixation for undisplaced scaphoid fractures is the method of choice for active people.