Update on Treatment for Wrist FracturesWrist fractures can be difficult to treat. Despite almost 100 years of treatment for scaphoid fractures, the best treatment is still not determined. The scaphoid bone is located in the first row of wrist bones just below the radius. The radius is one of two bones in the forearm. Both the radial bone and the scaphoid bone are on the thumb side of the wrist.
Poor healing or nonunion of a fractured scaphoid can result in wrist pain and loss of motion. These two symptoms then result in loss of function. The use of percutaneous fixation to treat scaphoid fractures is the subject of this report. Percutaneous fixation refers to a thin, headless screw inserted through the skin into the broken bone. The screw holds the broken pieces together until healing occurs.
This type of surgical repair can be done on both displaced and nondisplaced fractures. A displaced fracture is one in which the broken pieces have shifted and no longer line up evenly. A special type of X-ray imaging called fluoroscopy is used to help guide the surgeon.
The authors provide a detailed description of the surgery. Photos of the various headless compression screws commonly used in this operation are included. Additional photos of patient wrist placement during the procedure are also provided. X-rays showing the placement of the screw and evidence of healing eight weeks after the surgery are part of this report.
Studies reviewed on the use of percutaneous fixation for scaphoid fractures report 100 per cent success. The fracture healed with very few problems. Stable fractures respond well to this type of fixation. The ligaments and surrounding soft tissues don't have to be cut open. Patients don't have to wear a cast. They can get back to their regular activities quickly.
When complications do occur, the patients report wrist pain and joint stiffness. Wrist deformity is also possible if the fracture doesn't heal in a good position. Time lost at work is another result sometimes listed as a negative outcome.
All in all, percutaneous fixation results in a solid fracture union. Recent advances in screw design and fluoroscopy have made it possible to treat complicated scaphoid fractures without open surgery and without immobilization. Surgeons have found that the sooner the patient starts moving the wrist again, the faster their recovery. This is good news for any patient!
Andrew P. Gutow, MD. Percutanous Fixation of Scaphoid Fractures. In Journal of the American Academy of Orthopaedic Surgeons. August 2007. Vol. 15. No. 8. Pp. 474-485.
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