Advances in diagnosis and treatment of acute scaphoid fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Chenguang ,  CHEN Liang , HU Shaonan

Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, 200040, P.R.China;

Corresponding author：

CHEN Liang, Email: liangchen1960@163.com

Keywords：

Acute scaphoid fracture; imaging diagnosis; treatment advance

DOI：

10.7507/1002-1892.201811057

Video：

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Objective To review the advances in diagnosis and treatment of acute scaphoid fractures. Methods The characteristic, classification, diagnosis, and treatment of acute scaphoid fractures were reviewed and summarized. Results As one of the common fracture in hand, scaphoid fractures are generally classified as either undisplaced and stable or displaced and unstable. CT and MRI has best diagnostic specificity and sensitivity respectively. Most undisplaced and stable fractures can be treated successfully by plaster immobilization, whereas the displaced and unstable fractures have great prognosis after open reduction and internal fixation. Conclusion Acute scaphoid fractures should be diagnosed and treated at an early stage, and choose the appropriate treatment according to the location and stability of the fracture.

Citation： YANG Chenguang, CHEN Liang, HU Shaonan. Advances in diagnosis and treatment of acute scaphoid fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(4): 507-510. doi: 10.7507/1002-1892.201811057 Copy

1.	Berger RA. The anatomy of the scaphoid. Hand Clin, 2001, 17(4): 525-532.
2.	Duckworth AD, Jenkins PJ, Aitken SA, et al. Scaphoid fracture epidemiology. J Trauma Acute Care Surg, 2011, 72(2): E41-45.
3.	Dy CJ, Kazmers NH, Baty J, et al. An epidemiologic perspective on scaphoid fracture treatment and frequency of nonunion surgery in the USA. HSS J, 2018, 14(3): 245-250.
4.	Dias J, Kantharuban S. Treatment of scaphoid fractures: european approaches. Hand Clin, 2017, 33(3): 501-509.
5.	David C. Campbell’s Operative Orthopaedics. 13th edition. Canada: Elsevier Health Sciences, 2017: 3491-3492.
6.	Herbert TJ, Fisher WE. Management of the fractured scaphoid using a new bone screw. J Bone Joint Surg (Br), 1983, 66(1): 114-123.
7.	Duckworth AD, Buijze GA, Moran M, et al. Predictors of fracture following suspected injury to the scaphoid. J Bone Joint Surg (Br), 2012, 94(7): 961-968.
8.	Mallee WH, Henny EP, van Dijk CN, et al. Clinical diagnostic evaluation for scaphoid fractures: a systematic review and meta-analysis. J Hand Surg (Am), 2014, 39(9): 1683-1691. e2.
9.	Parvizi J, Wayman J, Kelly P, et al. Combining the clinical signs improves diagnosis of scaphoid fractures a prospective study with follow-up. J Hand Surg (Br), 1998, 23(3): 324-327.
10.	Geoghegan JM, Woodruff MJ, Bhatia R, et al. Undisplaced scaphoid waist fractures: is 4 weeks’ immobilisation in a below-elbow cast sufficient if a week 4 CT scan suggests fracture union? J Hand Surg (Eur Vol), 2009, 34(5): 631-637.
11.	Arsalan-Werner A, Sauerbier M, Mehling IM. Current concepts for the treatment of acute scaphoid fractures. Eur J Trauma Emerg Surg, 2016, 42(1): 3-10.
12.	Lozano-Calderón S, Blazar P, Zurakowski D, et al. Diagnosis of scaphoid fracture displacement with radiography and computed tomography. J Bone Joint Surg (Am), 2006, 88(12): 2695-2703.
13.	Temple CL, Ross DC, Bennett JD, et al. Comparison of sagittal computed tomography and plain film radiography in a scaphoid fracture model. J Hand Surg (Am), 2005, 30(3): 534-542.
14.	Mallee WH, Mellema JJ, Guitton TG, et al. 6-week radiographs unsuitable for diagnosis of suspected scaphoid fractures. Arch Orthop Trauma Surg, 2016, 136(6): 771-778.
15.	Schmitt R, Rosenthal H. Imaging of scaphoid fractures according to the new S3 guidelines. Rofo, 2016, 188(5): 459-469.
16.	Sauerbier M, Germann G, Dacho A. Current concepts in the treatment of scaphoid fractures. Eur J Trauma, 2004, 30(2): 80-92.
17.	Kumar S, O’Connor A, Despois M, et al. Use of early magnetic resonance imaging in the diagnosis of occult scaphoid fractures: the CAST Study (Canberra Area Scaphoid Trial). N Z Med J, 2005, 118(1209): U1296.
18.	Murthy NS. The role of magnetic resonance imaging in scaphoid fractures. J Hand Surg (Am), 2013, 38(10): 2047-2054.
19.	Yin ZG, Zhang JB, Kan SL, et al. Diagnosing suspected scaphoid fractures: a systematic review and meta-analysis. Clin Orthop Relat Res, 2010, 468(3): 723-734.
20.	Mallee WH, Wang J, Poolman RW, et al. Computed tomography versus magnetic resonance imaging versus bone scintigraphy for clinically suspected scaphoid fractures in patients with negative plain radiographs. Cochrane Database Syst Rev, 2015, (6): CD010023.
21.	Hiscox C, Lamothe J, White N, et al. Diagnosis of occult scaphoid fractures: a randomized, controlled trial comparing bone scans to radiographs for diagnosis. CJEM, 2014, 16(4): 296-303.
22.	Henriksen OM, Lonsdale MN, Jensen TD, et al. Two-dimensional fusion imaging of planar bone scintigraphy and radiographs in, patients with clinical scaphoid fracture: an imaging study. Acta Radiol, 2009, 50(1): 71-77.
23.	Buijze GA, Goslings JC, Rhemrev SJ, et al. Cast immobilization with and without immobilization of the thumb for nondisplaced and minimally displaced scaphoid waist fractures: a multicenter, randomized, controlled trial. J Hand Surg (Am), 2014, 39(4): 621-627.
24.	Doornberg JN, Buijze GA, Ham SJ, et al. Nonoperative treatment for acute scaphoid fractures: a systematic review and meta-analysis of randomized controlled trials. J Trauma, 2011, 71(4): 1073-1081.
25.	Davis EN, Chung KC, Kotsis SV, et al. A cost/utility analysis of open reduction and internal fixation versus cast immobilization for acute nondisplaced mid-waist scaphoid fractures. Plast Reconstr Surg, 2006, 117(4): 1223-1235.
26.	Grewal R, Suh N, Macdermid JC. Is casting for non-displaced simple scaphoid waist fracture effective? A CT based assessment of union Open Orthop J, 2016, 10: 431-438.
27.	Dias JJ, Dhukaram V, Abhinav A, et al. Clinical and radiological outcome of cast immobilisation versus surgical treatment of acute scaphoid fractures at a mean follow-up of 93 months. J Bone Joint Surg (Br), 2008, 90(7): 899-905.
28.	Grewal R, King GJ. An evidence-based approach to the management of acute scaphoid fractures. J Hand Surg (Am), 2009, 34(4): 732-734.
29.	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(1): 64-73.
30.	王孝辉, 王庆丰, 张彩丽, 等. 超声引导下经皮 Herbert 螺钉治疗新鲜无移位腕舟骨骨折. 中国修复重建外科杂志, 2018, 32(8): 989-992.
31.	Clementson M, Jørgsholm P, Besjakov J, et al. Conservative treatment versus arthroscopic-assisted screw fixation of scaphoid waist fractures-a randomized trial with minimum 4-year follow-up. J Hand Surg (Am), 2015, 40(7): 1341-1348.
32.	Ibrahim T, Qureshi A, Sutton AJ, et al. 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.
33.	Mayr E, Rudzki MM, Rudzki M, et al. Does low intensity, pulsed ultrasound speed healing of scaphoid fractures? Handchir Mikrochir Plast Chir, 2000, 32(2): 115-122.
34.	Hannemann PF, van Wezenbeek MR, Kolkman KA, et al. CT scan-evaluated outcome of pulsed electromagnetic fields in the treatment of acute scaphoid fractures: a randomised, multicentre, double-blind, placebo-controlled trial. Bone Joint J, 2014, 96-B(8): 1070-1076.
35.	Rettig AC, Kollias SC. Internal fixation of acute stable scaphoid fractures in the athlete. Am J Sports Med, 1994, 24(2): 182-186.
36.	Winston MJ, Weiland AJ. Scaphoid fractures in the athlete. Curr Rev Mmusculoskelet Med, 2017, 10(1): 38-44.
37.	Tait MA, Bracey JW, Gaston RG. Acute scaphoid fractures: a critical analysis review. JBJS Rev, 2016, 4(9): pii: 01874474-201609000-00004.
38.	Rettig ME, Raskin KB. Retrograde compression screw fixation of acute proximal pole scaphoid fractures. J Hand Surg (Am), 1999, 24(6): 1206-1210.
39.	Brogan DM, Moran SL, Shin AY. Outcomes of open reduction and internal fixation of acute proximal pole scaphoid fractures. Hand (N Y), 2015, 10(2): 227-232.
40.	Schreiber JJ, Kang L, Hearns KA, et al. Micro screw fixation for small proximal pole scaphoid fractures with distal radius bone graft. J Wrist Surg, 2018, 7(4): 319-323.
41.	Ek ET, Wang K. Fixation of ultrasmall proximal pole scaphoid fractures using bioabsorbable osteochondral fixation nails. J Hand Surg (Am), 2017, 42(9): 758. e1-758. e4.
42.	Capito AE, Higgins JP. Scaphoid overstuffing: the effects of the dimensions of scaphoid reconstruction on scapholunate alignment. J Hand Surg (Am), 2013, 38(12): 2419-2425.
43.	Alexa O, Veliceasa B. Percutaneous Herbert screw osteosynthesis in trans-scaphoid perilunate fracture-dislocations. Rev Med Chir Soc Med Nat Iasi, 2013, 117(2): 409-413.
44.	Melone CP Jr, Murphy MS, Raskin KB. Perilunate injuries. Repair by dual dorsal and volar approaches. Hand Clin, 2000, 16(3): 439-448.
45.	Knoll VD, Allan C, Trumble TE. Trans-scaphoid perilunate fracture dislocations: results of screw fixation of the scaphoid and lunotriquetral repair with a dorsal approach. J Hand Surg (Am), 2005, 30(6): 1145-1152.
46.	Oh WT, Choi YR, Kang HJ, et al. Comparative outcome analysis of arthroscopic-assisted versus open reduction and fixation of trans-scaphoid perilunate fracture dislocations. Arthroscopy, 2017, 33(1): 92-100.

1. Berger RA. The anatomy of the scaphoid. Hand Clin, 2001, 17(4): 525-532.
2. Duckworth AD, Jenkins PJ, Aitken SA, et al. Scaphoid fracture epidemiology. J Trauma Acute Care Surg, 2011, 72(2): E41-45.
3. Dy CJ, Kazmers NH, Baty J, et al. An epidemiologic perspective on scaphoid fracture treatment and frequency of nonunion surgery in the USA. HSS J, 2018, 14(3): 245-250.
4. Dias J, Kantharuban S. Treatment of scaphoid fractures: european approaches. Hand Clin, 2017, 33(3): 501-509.
5. David C. Campbell’s Operative Orthopaedics. 13th edition. Canada: Elsevier Health Sciences, 2017: 3491-3492.
6. Herbert TJ, Fisher WE. Management of the fractured scaphoid using a new bone screw. J Bone Joint Surg (Br), 1983, 66(1): 114-123.
7. Duckworth AD, Buijze GA, Moran M, et al. Predictors of fracture following suspected injury to the scaphoid. J Bone Joint Surg (Br), 2012, 94(7): 961-968.
8. Mallee WH, Henny EP, van Dijk CN, et al. Clinical diagnostic evaluation for scaphoid fractures: a systematic review and meta-analysis. J Hand Surg (Am), 2014, 39(9): 1683-1691. e2.
9. Parvizi J, Wayman J, Kelly P, et al. Combining the clinical signs improves diagnosis of scaphoid fractures a prospective study with follow-up. J Hand Surg (Br), 1998, 23(3): 324-327.
10. Geoghegan JM, Woodruff MJ, Bhatia R, et al. Undisplaced scaphoid waist fractures: is 4 weeks’ immobilisation in a below-elbow cast sufficient if a week 4 CT scan suggests fracture union? J Hand Surg (Eur Vol), 2009, 34(5): 631-637.
11. Arsalan-Werner A, Sauerbier M, Mehling IM. Current concepts for the treatment of acute scaphoid fractures. Eur J Trauma Emerg Surg, 2016, 42(1): 3-10.
12. Lozano-Calderón S, Blazar P, Zurakowski D, et al. Diagnosis of scaphoid fracture displacement with radiography and computed tomography. J Bone Joint Surg (Am), 2006, 88(12): 2695-2703.
13. Temple CL, Ross DC, Bennett JD, et al. Comparison of sagittal computed tomography and plain film radiography in a scaphoid fracture model. J Hand Surg (Am), 2005, 30(3): 534-542.
14. Mallee WH, Mellema JJ, Guitton TG, et al. 6-week radiographs unsuitable for diagnosis of suspected scaphoid fractures. Arch Orthop Trauma Surg, 2016, 136(6): 771-778.
15. Schmitt R, Rosenthal H. Imaging of scaphoid fractures according to the new S3 guidelines. Rofo, 2016, 188(5): 459-469.
16. Sauerbier M, Germann G, Dacho A. Current concepts in the treatment of scaphoid fractures. Eur J Trauma, 2004, 30(2): 80-92.
17. Kumar S, O’Connor A, Despois M, et al. Use of early magnetic resonance imaging in the diagnosis of occult scaphoid fractures: the CAST Study (Canberra Area Scaphoid Trial). N Z Med J, 2005, 118(1209): U1296.
18. Murthy NS. The role of magnetic resonance imaging in scaphoid fractures. J Hand Surg (Am), 2013, 38(10): 2047-2054.
19. Yin ZG, Zhang JB, Kan SL, et al. Diagnosing suspected scaphoid fractures: a systematic review and meta-analysis. Clin Orthop Relat Res, 2010, 468(3): 723-734.
20. Mallee WH, Wang J, Poolman RW, et al. Computed tomography versus magnetic resonance imaging versus bone scintigraphy for clinically suspected scaphoid fractures in patients with negative plain radiographs. Cochrane Database Syst Rev, 2015, (6): CD010023.
21. Hiscox C, Lamothe J, White N, et al. Diagnosis of occult scaphoid fractures: a randomized, controlled trial comparing bone scans to radiographs for diagnosis. CJEM, 2014, 16(4): 296-303.
22. Henriksen OM, Lonsdale MN, Jensen TD, et al. Two-dimensional fusion imaging of planar bone scintigraphy and radiographs in, patients with clinical scaphoid fracture: an imaging study. Acta Radiol, 2009, 50(1): 71-77.
23. Buijze GA, Goslings JC, Rhemrev SJ, et al. Cast immobilization with and without immobilization of the thumb for nondisplaced and minimally displaced scaphoid waist fractures: a multicenter, randomized, controlled trial. J Hand Surg (Am), 2014, 39(4): 621-627.
24. Doornberg JN, Buijze GA, Ham SJ, et al. Nonoperative treatment for acute scaphoid fractures: a systematic review and meta-analysis of randomized controlled trials. J Trauma, 2011, 71(4): 1073-1081.
25. Davis EN, Chung KC, Kotsis SV, et al. A cost/utility analysis of open reduction and internal fixation versus cast immobilization for acute nondisplaced mid-waist scaphoid fractures. Plast Reconstr Surg, 2006, 117(4): 1223-1235.
26. Grewal R, Suh N, Macdermid JC. Is casting for non-displaced simple scaphoid waist fracture effective? A CT based assessment of union Open Orthop J, 2016, 10: 431-438.
27. Dias JJ, Dhukaram V, Abhinav A, et al. Clinical and radiological outcome of cast immobilisation versus surgical treatment of acute scaphoid fractures at a mean follow-up of 93 months. J Bone Joint Surg (Br), 2008, 90(7): 899-905.
28. Grewal R, King GJ. An evidence-based approach to the management of acute scaphoid fractures. J Hand Surg (Am), 2009, 34(4): 732-734.
29. 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(1): 64-73.
30. 王孝辉, 王庆丰, 张彩丽, 等. 超声引导下经皮 Herbert 螺钉治疗新鲜无移位腕舟骨骨折. 中国修复重建外科杂志, 2018, 32(8): 989-992.
31. Clementson M, Jørgsholm P, Besjakov J, et al. Conservative treatment versus arthroscopic-assisted screw fixation of scaphoid waist fractures-a randomized trial with minimum 4-year follow-up. J Hand Surg (Am), 2015, 40(7): 1341-1348.
32. Ibrahim T, Qureshi A, Sutton AJ, et al. 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.
33. Mayr E, Rudzki MM, Rudzki M, et al. Does low intensity, pulsed ultrasound speed healing of scaphoid fractures? Handchir Mikrochir Plast Chir, 2000, 32(2): 115-122.
34. Hannemann PF, van Wezenbeek MR, Kolkman KA, et al. CT scan-evaluated outcome of pulsed electromagnetic fields in the treatment of acute scaphoid fractures: a randomised, multicentre, double-blind, placebo-controlled trial. Bone Joint J, 2014, 96-B(8): 1070-1076.
35. Rettig AC, Kollias SC. Internal fixation of acute stable scaphoid fractures in the athlete. Am J Sports Med, 1994, 24(2): 182-186.
36. Winston MJ, Weiland AJ. Scaphoid fractures in the athlete. Curr Rev Mmusculoskelet Med, 2017, 10(1): 38-44.
37. Tait MA, Bracey JW, Gaston RG. Acute scaphoid fractures: a critical analysis review. JBJS Rev, 2016, 4(9): pii: 01874474-201609000-00004.
38. Rettig ME, Raskin KB. Retrograde compression screw fixation of acute proximal pole scaphoid fractures. J Hand Surg (Am), 1999, 24(6): 1206-1210.
39. Brogan DM, Moran SL, Shin AY. Outcomes of open reduction and internal fixation of acute proximal pole scaphoid fractures. Hand (N Y), 2015, 10(2): 227-232.
40. Schreiber JJ, Kang L, Hearns KA, et al. Micro screw fixation for small proximal pole scaphoid fractures with distal radius bone graft. J Wrist Surg, 2018, 7(4): 319-323.
41. Ek ET, Wang K. Fixation of ultrasmall proximal pole scaphoid fractures using bioabsorbable osteochondral fixation nails. J Hand Surg (Am), 2017, 42(9): 758. e1-758. e4.
42. Capito AE, Higgins JP. Scaphoid overstuffing: the effects of the dimensions of scaphoid reconstruction on scapholunate alignment. J Hand Surg (Am), 2013, 38(12): 2419-2425.
43. Alexa O, Veliceasa B. Percutaneous Herbert screw osteosynthesis in trans-scaphoid perilunate fracture-dislocations. Rev Med Chir Soc Med Nat Iasi, 2013, 117(2): 409-413.
44. Melone CP Jr, Murphy MS, Raskin KB. Perilunate injuries. Repair by dual dorsal and volar approaches. Hand Clin, 2000, 16(3): 439-448.
45. Knoll VD, Allan C, Trumble TE. Trans-scaphoid perilunate fracture dislocations: results of screw fixation of the scaphoid and lunotriquetral repair with a dorsal approach. J Hand Surg (Am), 2005, 30(6): 1145-1152.
46. Oh WT, Choi YR, Kang HJ, et al. Comparative outcome analysis of arthroscopic-assisted versus open reduction and fixation of trans-scaphoid perilunate fracture dislocations. Arthroscopy, 2017, 33(1): 92-100.

Chinese Journal of Reparative and Reconstructive Surgery

Advances in diagnosis and treatment of acute scaphoid fractures

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