The Clinical Survey on Scaphoid Fractures

Lee, Kwang Suk; Park, Sang Won; Park, Jung Ho; Lee, Hong Kun

Abstract

Scaphoid fractures are the most common fracture and early diagnoses are very important because of preventing from serious complications such as nonunion, avascular necrosis, and disability of wrist joint. There are a few reports of clinical survey of scaphoid fractures, but not to be reported the evaluation for the close relation among mechanism, modes of treatment, especially operation and late complications. This paper reports more clear corelationships among them as mentioned as above through clinical study of scaphoid fractures. The authors have surveyed the clinical study of 26 cases of scaphoid fractures from July, 1983 to November, 1989 at Department of Orthopedic Surgery, Haewha hospital of Korea University. The following conclusions were obtained through clinical survey. 1. Among 26 cases, they were 25 males and one female between 20 and 50 years of age, and ocalization was 16 in right and 10 in left. They were 21 fresh fractures and five nonunions. 2. Mechanism of injuries had revealed fall down or slip down in 13 cases, roller injury in five cases, fisting injury in four cases, direct trauma in two cases, and traffic accident in two cases. Fracture loeation was four cases in proximal 1/3, 17 cases in middle 1/3, and five cases in distal 1/3. 3. Operations using volar approachs in 12 cases and dorsal approachs in three cases had been done for ten cases of displaced fresh fractures and five cases of neglected nonunions. 4. Eleven undisplaced fresh fractures were treated with short arm thumb spica cast but one with. long arm cast. Of ten displaced fresh fractures treated by open reduction, seven cases were treated with Herbert screw, two cases with K-wire, and one case with treated by open reduction and bone graft with Herbert screw fixation in three cases, K-wire fixation in one case, and open reduction with bone graft in one case. 5. Unions were obtained at average 11.5 weeks in eight of 11 cases treated with conservative treatment for fresh fractures, 12 weeks in eight of 10 open reduction cases of fresh fractures, and 20 weeks in three of five neglected nonunion cases. 6. Of eleven conservatively treated cases, two cases resulted in nonunion and other one case in avascular necrosis. Of ten treated with open reduction, one complicated in delayed union, other one nonunion. Of five neglected nonunion cases treated by open reduction added with bone graft, one remained in nonunion and other one case complicated with arthritis and nonunion.