Management of late-diagnosed scaphoid fractures.
BACKGROUND
Scaphoid fractures are among the most common types of carpal bone injury; they can be easily overlooked in the acute stage. Scaphoid fractures detected in the subacute stage require a more meticulous and prompt approach, to prevent chronicity and regain wrist function.


METHODS
The records of 30 patients were selected from 97 with scaphoid fractures surgically treated between 1994 and 2002. Fractures that were diagnosed between 2 weeks and 5 months (average, 2.2 months) after the injury were included. We report the fracture patterns and locations, as determined from radiographs, as well as the surgical methods used. The mean follow-up was 2.5 years.


RESULTS
Oblique fractures (60%) were the most commonly overlooked fractures. Twenty-six patients (87%) underwent open surgery, and 23 (77%) required bone grafts. Percutaneous fixation was indicated for only four patients, whose fractures were reducible via either fluoroscopic or arthroscopic guidance. Osseous unions were achieved for 29 (97%) patients; these patients returned to their pre-injury level of activity. The average union time was 10.6 weeks.


CONCLUSIONS
Oblique-type scaphoid fractures are potentially unstable and may result in detrimental sequelae if overlooked in the acute stage. Accurate diagnosis is possible through critical skepticism and the meticulous scrutiny of radiographs. Prompt surgical intervention is associated with promising outcomes.
Chen
Alvin Chao-Yu
AC
Department of Orthopaedic Surgery, Chang Gung Memorial Hospital & University, 5, Fu-Shin Street, Kweishan, Taoyuan 333, Taiwan. alvinchen@adm.cgmh.org.tw
Lee
Mel S
MS
Ueng
Steve Wen-Neng
SW
Chen
Wen Jer
WJ
D000328:Adult; D000368:Aged; D000465:Algorithms; D016025:Bone Transplantation / Q000379:methods; D057210:Delayed Diagnosis; D005260:Female; D005592:Fracture Fixation / Q000379:methods*; D017102:Fracture Healing; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D020127:Recovery of Function; D012189:Retrospective Studies; D021361:Scaphoid Bone / Q000293:injuries*; D014954:Wrist Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult