title: Examination and treatment of scaphoid fractures and pseudarthrosis.
abstract: BACKGROUND
  About 2,000 patients annually incur a fractured scaphoid in Norway. Assessment and diagnosis can be difficult, and fractures are overlooked. Scaphoid fractures have traditionally been cast-immobilised, but for the last decade screw fixing has been used increasingly, and offers hope of a higher healing frequency and improved function. Some scaphoid fractures are not diagnosed in the acute phase and some do not heal after treatment. Patients may then end up with painful pseudarthrosis. The purpose of this article is to provide an overview of the assessment, treatment and outcomes of scaphoid fractures.
  
  
  METHODS
  The article is based on literature searches in PubMed and the authors' own clinical experience.
  
  
  RESULTS
  Primary diagnosis of scaphoid fractures and subsequent plaster cast immobilisation yield very good clinical results. Surgery should be limited to displaced fractures, fractures forming part of more extensive wrist injuries and exceptional other cases. Results comparable a quality equivalent to cast immobilisation are achieved by experienced surgeons in this area. Untreated scaphoid fractures often result in painful pseudarthrosis with subsequent abnormal position of the carpal bones and secondary arthrosis. This outcome can be counteracted by surgery on old fractures with bone grafting, internal fixation and cast immobilisation.
  
  
  CONCLUSIONS
  Norwegian procedures for treating scaphoid fractures/pseudarthrosis are consistent with internationally documented good practice. Assessment of wrist pain following falls can be improved by conducting clinical tests for scaphoid fracture and radiology with four wrist projections. In the event of clinical suspicion, but no X-ray findings, the patient should be referred for a CT or MRI scan.
authors.affiliation: Seksjon for overekstremitets- og mikrokirurgi Ortopedisk avdeling Oslo universitetssykehus, Rikshospitalet.
authors.forename: Ole
authors.initials: O
authors.lastname: Reigstad
authors.affiliation: Seksjon for overekstremitets- og mikrokirurgi Ortopedisk avdeling Oslo universitetssykehus, Rikshospitalet.
authors.forename: Rasmus
authors.initials: R
authors.lastname: Thorkildsen
authors.affiliation: Seksjon for overekstremitets- og mikrokirurgi Ortopedisk avdeling Oslo universitetssykehus, Rikshospitalet.
authors.forename: Christian
authors.initials: C
authors.lastname: Grimsgaard
authors.affiliation: Oslo skadelegevakt Oslo universitetssykehus.
authors.forename: Knut
authors.initials: K
authors.lastname: Melhuus
authors.affiliation: Seksjon for overekstremitets- og mikrokirurgi Ortopedisk avdeling Oslo universitetssykehus, Rikshospitalet.
authors.forename: Magne
authors.initials: M
authors.lastname: Røkkum
mesh_terms: D001863:Bone Screws; D002370:Casts, Surgical; D019091:Critical Pathways; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000628:therapy; D006801:Humans; D011542:Pseudarthrosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D011859:Radiography; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D014954:Wrist Injuries / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000628:therapy