Affordable Access

deepdyve-link
Publisher Website

Examination and treatment of scaphoid fractures and pseudarthrosis.

Authors
  • Reigstad, Ole1
  • Thorkildsen, Rasmus1
  • Grimsgaard, Christian1
  • Melhuus, Knut2
  • Røkkum, Magne1
  • 1 Seksjon for overekstremitets- og mikrokirurgi Ortopedisk avdeling Oslo universitetssykehus, Rikshospitalet.
  • 2 Oslo skadelegevakt Oslo universitetssykehus.
Type
Published Article
Journal
Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke
Publication Date
Jun 30, 2015
Volume
135
Issue
12-13
Pages
1138–1142
Identifiers
DOI: 10.4045/tidsskr.14.1256
PMID: 26130547
Source
Medline
Language
Norwegian
License
Unknown

Abstract

About 2,000 patients annually incur a fractured scaphoid in Norway. Assessment and diagnosis can be difficult, and fractures are overlooked. Scaphoid fractures have traditionally been cast-immobilised, but for the last decade screw fixing has been used increasingly, and offers hope of a higher healing frequency and improved function. Some scaphoid fractures are not diagnosed in the acute phase and some do not heal after treatment. Patients may then end up with painful pseudarthrosis. The purpose of this article is to provide an overview of the assessment, treatment and outcomes of scaphoid fractures. The article is based on literature searches in PubMed and the authors' own clinical experience. Primary diagnosis of scaphoid fractures and subsequent plaster cast immobilisation yield very good clinical results. Surgery should be limited to displaced fractures, fractures forming part of more extensive wrist injuries and exceptional other cases. Results comparable a quality equivalent to cast immobilisation are achieved by experienced surgeons in this area. Untreated scaphoid fractures often result in painful pseudarthrosis with subsequent abnormal position of the carpal bones and secondary arthrosis. This outcome can be counteracted by surgery on old fractures with bone grafting, internal fixation and cast immobilisation. Norwegian procedures for treating scaphoid fractures/pseudarthrosis are consistent with internationally documented good practice. Assessment of wrist pain following falls can be improved by conducting clinical tests for scaphoid fracture and radiology with four wrist projections. In the event of clinical suspicion, but no X-ray findings, the patient should be referred for a CT or MRI scan.

Report this publication

Statistics

Seen <100 times