Abstract
Background Minimally displaced scaphoid fractures can be challenging to diagnose and treat.
Cannulated scaphoid screws have made percutaneous stabilization highly effective.
Questions Would minimally invasive operative treatment of minimally displaced scaphoid fractures
yield faster return to work when compared with patients treated conservatively? How
do functional and patient satisfaction scores compare between the two groups at 12-months
follow-up?
Patients and Methods Records from 18 patients (mean age 28.6 years) treated surgically were retrospectively
reviewed and compared with a group of 10 patients (mean age 33.3 years, p = 0.74) treated nonoperatively. Inclusion criteria were a minimum follow-up period
of 12 months and radiographic union. Time to return to work was compared between groups.
At 12 months' follow-up, wrist range of motion (ROM) and grip strength were compared,
as well as pain, satisfaction, and overall wrist function were evaluated by the visual
analogue scale (VAS) and the Mayo modified wrist score (MMWS).
Results The mean time to return to work for the operated group was 39.75 days, while for
the nonoperated group it was 88.14 days (p = 0.002). At the 12 months' follow-up, mean ROM, grip strength, and VAS score did
not differ between groups. The mean MMWS was 98.75 for the operated group and 87.5
for the nonoperated group, indicating a better result in patients treated operatively
(p = 0.03). In addition, two failures of instrumentation were recorded, a seldom seen
complication.
Conclusion Percutaneous fixation of minimally displaced scaphoid fractures allows faster return
to work and leaves patients more satisfied with their wrist function compared with
plaster immobilization at 12 months' follow-up.
Level of evidence This is a Level III, retrospective, case–control study.
Keywords scaphoid fracture - percutaneous fixation - nonoperative treatment - cannulated screws
- cast treatment
