Results of percutaneous fixation of fresh scaphoid fractures | ||
| Benha Journal of Applied Sciences | ||
| Article 46, Volume 6, Issue 6, December 2021, Pages 365-374 PDF (654.08 K) | ||
| Document Type: Original Research Papers | ||
| DOI: 10.21608/bjas.2021.214841 | ||
| Authors | ||
| A.S. Allam; A.S. El-Gazzar; H.A. El-Attar; H.E. El-daboor | ||
| Orthopaedic Surgery, Dept., Faculty of Medicine, Benha Univ., Benha, Egypt | ||
| Abstract | ||
| Background: Fractures of scaphoid are prevalent, and many times are difficult to identify and heal. Fracture scaphoid may cause extended morbidity and absences from work in young adult in which they are most prevalent. Non displaced fractures of the scaphoid waist were handled with immobilization as conventional therapy, with possibly resulting reduction of wrist motion . include extended cast immobility, and constitute a severe economical hardship. Immobilization may be required for up to 3 months, and patient compliance is therefore generally poor, particularly in the presence of low symptom levels, when plasters may be removed early, resulting in delayed union or nonunion. For nonoperative therapy of acute scaphoid waist fractures, numerous forms of casts are utilized in normal practice. These include Colles’ cast with wrist in flexion or extension; scaphoid cast below or above elbow; scaphoid cast including or omitting the thumb. This research aims at examining the efficiency of percutaneous cannulated Herbert's screw repair of new scaphoid fractures in providing good result. Methods: Fifteen patients with new scaphoid fractures repaired with percutaneous Herbert screw were included in this investigation. This research was done at Banha university hospital and Kafr El-Sheikh general hospital between October 2019 and August 2020. These patients were followed up for an average of 10 months (8-12 months) post-operatively. This research covered non-displaced or mildly displaced complete waist fractures (B2) according to Herbert's classification. We utilized volar technique in all situations. Results: The clinical findings were assessed as outstanding in 12 patients (80 percent ) and good in 3 individuals (20 percent ). (20 percent ). By the conclusion of the follow up period 12 patients (80 percent ) had no pain at all, and 3 patients (20 percent ) experienced minor intermittent discomfort. Twelve patients (80 percent ) restored wrist range of motion with flexion & extension higher than 120 degrees, two patients (13.3 percent ) regained mobility between 119 to 110 degree, and one patient (6.7 percent ) regained motion between 90 to 99 degrees. Thirteen patients (86.7 percent ) have 90 percent to 100 percent grip strength compared to the normal side, two (13.3 percent ) patients has 75 percent to 89 percent grip strength compared to the normal side. Comparing the functional end outcomes with smoking, no significant association was identified. (P>0.05 statistically insignificant). Significant association was established between central location of the screw and the functional end outcomes, (P<0.05 statistically significant). The fixation group contained 11 and the cast group 14 patients. The cast group was immobilized in a long cast for 6 weeks, followed by a short cast until union was attained, which was verified clinically and radiographically. The fixation group was immobilized with a brief cast for 10 days and a detachable splint till union. All patients were followed up for 25 months, and all fractures attained union. Analysis demonstrated substantial decrease in time to union in the fixation group (7 vs. 12 weeks, p = 0.0003) and time to return to full duty in the fixation group (8 vs. 15 weeks, p = 0.0001). There was no significant link between age and time to union, (P>0.05 statistically insignificant). Significant connection was established between smoking and time of fracture union, (P<0.05 statistically significant). No Significant connection was established between the time of union and time elapsed before operation, (P>0.05 statistically insignificant). Significant association was established between central location of the screw and the time of union outcomes, (P<0.05 statistically significant). Regarding complications in this research, screw protrusion was detected in one instance however there was no major influence on the clinical result according to MMS score. Localized osteopenia as a symptom of reflex sympathetic osteodystrophy occurred in one patient with concomitant fracture distal radius owing to immobilization and was amenable to physiotherapy after removal of cast and k-wire. Superficial skin infection developed in one patient treated with daily dressing and antibiotics and the infection disappeared after 5 days. There was no nonunion, no delayed union, and no loosening of screw. Conclusion: Percutaneous screw fixation of minimally or non-displaced scaphoid waist provides a stable mode of osteosynthesis which allows for reduced time to bony union with consequent earlier return to sports or employment with minimized loss of motion, grip strength, and muscle atrophy attributed to prolonged cast immobilization. Using the volar approach, it is simple to establish and sustain reduction, better identification of the bone landmarks and easier interpretation of the fluoroscopically produced pictures. | ||
| Keywords | ||
| percutaneous fixation; fresh scaphoid fractures | ||
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