Simultaneous Fractures of the Ipsilateral Scaphoid and Distal Radius

Abstract

Background Ipsilateral fractures of the distal radius and scaphoid are rare, with few reports describing mechanisms of injury, fracture patterns, and treatment approaches.

Purpose This article describes the clinical and radiographic features of ipsilateral distal radius and scaphoid fractures occurring simultaneously.

Materials and Methods Electronic databases from 2007 to 2017 at a single Level 1 trauma center were reviewed for patients with concurrent fractures of the distal radius and scaphoid. Patient demographics, injury mechanism, scaphoid and distal radius fracture pattern, treatment approach, and radiographic healing were studied.

Results Twenty-three patients were identified. Nineteen of the 23 (83%) were males, and 19 of 23 (83%) of the injury mechanisms were considered high energy. Twenty-two of the 23 (96%) scaphoid fractures were nondisplaced, all treated with screw fixation. Most distal radius fractures were displaced and comminuted, 17 of 23 (74%) were intra-articular. All distal radius fractures were treated surgically with internal and/or external fixation. Three patients were lost to follow-up. Average follow-up of the remaining 20 was to 19.8 weeks. Nineteen of the 20 (95%) scaphoids healed, one scaphoid went on to nonunion with avascular necrosis. All 20 radius fractures healed, 16 of 20 (80%) in anatomic alignment.

Conclusion Ipsilateral fractures of the distal radius and scaphoid are rare and are usually result of high-energy mechanisms. The scaphoid fracture is usually a nondisplaced fracture at the waist. The distal radius fracture pattern varies but most are displaced and comminuted. The union rate of the scaphoid is high, even if subjected to radiocarpal distraction required for distal radius management.

Level of Evidence Therapeutic level IV study.

Keywords

distal radius fractures - scaphoid fractures - ipsilateral fractures

Note

This study was approved by the Institutional Review Board.

• References

• 1 Hove LM. Simultaneous scaphoid and distal radial fractures. J Hand Surg [Br] 1994; 19 (03) 384-388
• 2 Jenkins NH, Jones DG. Simultaneous Colles' and scaphoid fractures: treatment by combined internal and external fixation. Am J Emerg Med 1986; 4 (03) 229-230
• 3 Komura S, Yokoi T, Nonomura H, Tanahashi H, Satake T, Watanabe N. Incidence and characteristics of carpal fractures occurring concurrently with distal radius fractures. J Hand Surg Am 2012; 37 (03) 469-476
• 4 Oskam J, De Graaf JS, Klasen HJ. Fractures of the distal radius and scaphoid. J Hand Surg [Br] 1996; 21 (06) 772-774
• 5 Richards RR, Ghose T, McBroom RJ. Ipsilateral fractures of the distal radius and scaphoid treated by Herbert screw and external skeletal fixation. A report of two cases. Clin Orthop Relat Res 1992; (282) 219-221
• 6 Smith JT, Keeve JP, Bertin KC, Mann RJ. Simultaneous fractures of the distal radius and scaphoid. J Trauma 1988; 28 (05) 676-679
• 7 Stother IG. A report of 3 cases of simultaneous Colles' and scaphoid fractures. Injury 1976; 7 (03) 185-188
• 8 Tountas AA, Waddell JP. Simultaneous fractures of the distal radius and scaphoid. J Orthop Trauma 1987; 1 (04) 312-317
• 9 Trumble TE, Benirschke SK, Vedder NB. Ipsilateral fractures of the scaphoid and radius. J Hand Surg Am 1993; 18 (01) 8-14
• 10 Vukov V, Ristić K, Stevanović M, Bumbasirević M. Simultaneous fractures of the distal end of the radius and the scaphoid bone. J Orthop Trauma 1988; 2 (02) 120-123
• 11 Slade III JF, Taksali S, Safanda J. Combined fractures of the scaphoid and distal radius: a revised treatment rationale using percutaneous and arthroscopic techniques. Hand Clin 2005; 21 (03) 427-441
• 12 Chang CH, Tsai YS, Sun JS, Hou SM. Ipsilateral distal radius and scaphoid fractures. J Formos Med Assoc 2000; 99 (09) 733-737
• 13 Proubasta IR, Lluch AL. Concomitant fractures of the scaphoid and the distal end of the radius: treatment by external fixation. A report of two cases. J Bone Joint Surg Am 1991; 73 (06) 938-940
• 14 Orbay JL, Fernandez DL. Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg Am 2002; 27 (02) 205-215
• 15 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
• 16 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-A [phone]
• 17 Saedén B, Törnkvist H, Ponzer S, Höglund M. Fracture of the carpal scaphoid. A prospective, randomised 12-year follow-up comparing operative and conservative treatment. J Bone Joint Surg Br 2001; 83 (02) 230-234
• 18 Buijze GA, Doornberg JN, Ham JS, Ring D, Bhandari M, Poolman RW. Surgical compared with conservative treatment for acute nondisplaced or minimally displaced scaphoid fractures: a systematic review and meta-analysis of randomized controlled trials. J Bone Joint Surg Am 2010; 92 (06) 1534-1544
• 19 Dias JJ, Wildin CJ, Bhowal B, Thompson JR. Should acute scaphoid fractures be fixed? A randomized controlled trial. J Bone Joint Surg Am 2005; 87 (10) 2160-2168
• 20 Vinnars B, Pietreanu M, Bodestedt A, Ekenstam FA, Gerdin B. Nonoperative compared with operative treatment of acute scaphoid fractures. A randomized clinical trial. J Bone Joint Surg Am 2008; 90 (06) 1176-1185
• 21 Ten Berg PW, Drijkoningen T, Strackee SD, Buijze GA. Classifications of acute scaphoid fractures: a systematic literature review. J Wrist Surg 2016; 5 (02) 152-159
• 22 Mignemi ME, Byram IR, Wolfe CC. , et al. Radiographic outcomes of volar locked plating for distal radius fractures. J Hand Surg Am 2013; 38 (01) 40-48
• 23 Dias JJ, Taylor M, Thompson J, Brenkel IJ, Gregg PJ. Radiographic signs of union of scaphoid fractures. An analysis of inter-observer agreement and reproducibility. J Bone Joint Surg Br 1988; 70 (02) 299-301
• 24 Buijze GA, Jørgsholm P, Thomsen NO, Bjorkman A, Besjakov J, Ring D. Diagnostic performance of radiographs and computed tomography for displacement and instability of acute scaphoid waist fractures. J Bone Joint Surg Am 2012; 94 (21) 1967-1974
• 25 Grewal R, Frakash U, Osman S, McMurtry RY. A quantitative definition of scaphoid union: determining the inter-rater reliability of two techniques. J Orthop Surg 2013; 8: 28
• 26 Grewal R, Suh N, Macdermid JC. Use of computed tomography to predict union and time to union in acute scaphoid fractures treated nonoperatively. J Hand Surg Am 2013; 38 (05) 872-877
• 27 Smith ML, Bain GI, Chabrel N, Turner P, Carter C, Field J. Using computed tomography to assist with diagnosis of avascular necrosis complicating chronic scaphoid nonunion. J Hand Surg Am 2009; 34 (06) 1037-1043
• 28 Lozano-Calderón S, Blazar P, Zurakowski D, Lee SG, Ring D. Diagnosis of scaphoid fracture displacement with radiography and computed tomography. J Bone Joint Surg Am 2006; 88 (12) 2695-2703
• 29 ten Berg PW, Dobbe JG, Strackee SD, Streekstra GJ. Quantifying scaphoid malalignment based upon height-to-length ratios obtained by 3-dimensional computed tomography. J Hand Surg Am 2015; 40 (01) 67-73