title: Union of Scaphoid Waist Fractures Assessed by CT Scan.
abstract: Background Union of a scaphoid fracture is difficult to assess on a standard series of radiographs. An unnecessary and prolonged immobilization is inconvenient and may impair functional outcome. Although operative treatment permits early mobilization, its influence on time to union is still uncertain. Purpose To assess union of scaphoid waist fractures based on computed tomography (CT) scan at 6 weeks, and to compare time to union between conservative treatment and arthroscopically assisted screw fixation. Patients and methods CT scan in the longitudinal axis of the scaphoid was used to provide fracture characteristics, and to assess bone union at 6 weeks in 65 consecutive patients with scaphoid waist fractures. In a randomized subgroup from this cohort with nondisplaced fractures, we compared time to union between conservative treatment (n = 23) and arthroscopically assisted screw fixation (n = 15). Results Overall, at 6 weeks we found a 90% union rate for non- or minimally displaced fracture treated conservatively, and 82% for those who underwent surgery. In the randomized subgroup of nondisplaced fractures, no significant difference in time to union was demonstrated between those treated conservatively and those who underwent surgery. The conservatively treated fractures from this subgroup with prolonged time to union (10 to 14 weeks) were comminuted, demonstrating a radial cortical or corticospongious fragment. Conclusion The majority of non- or minimally displaced scaphoid waist fractures are sufficiently treated with 6 weeks in a cast. Screw fixation does not reduce time to fracture union compared with conservative treatment. Level of Evidence level II, Therapeutic study.
authors.affiliation: Department of Clinical Sciences Malmö - Hand Surgery, Lund University, Skåne University Hospital, Malmö, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Clementson
authors.affiliation: Department of Clinical Sciences Malmö - Hand Surgery, Lund University, Skåne University Hospital, Malmö, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Jørgsholm
authors.affiliation: Department of Radiology, Skåne University Hospital, Malmö, Sweden.
authors.forename: Jack
authors.initials: J
authors.lastname: Besjakov
authors.affiliation: Department of Clinical Sciences Malmö - Hand Surgery, Lund University, Skåne University Hospital, Malmö, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Björkman
authors.affiliation: Department of Clinical Sciences Malmö - Hand Surgery, Lund University, Skåne University Hospital, Malmö, Sweden.
authors.forename: Niels
authors.initials: N
authors.lastname: Thomsen
keywords: CT scan; arthroscopy; bone union; scaphoid fracture; wrist