![]() Previous studies have demonstrated an earlier return to sport when comparing surgical to conservative management for undisplaced unstable fractures of the scaphoid waist: However, treatment practises of these injuries still remain varied among clinicians. The treatment of undisplaced unstable fractures remains controversial: Some clinicians advise conservative management with a scaphoid or forearm cast for 8 to 12 wk while others recommend surgical management with internal screw fixation (often feasible through a percutaneous approach). Occasionally, displaced distal fractures of the scaphoid tubercle, which are symptomatic, can be treated with surgical excision. Due to the risk of non-union and avascular necrosis, displaced fractures are treated surgically with open reduction and internal fixation. Undisplaced stable fractures (A1 and A2) are routinely treated conservatively with a scaphoid or forearm cast for 8 wk to 12 wk, until the fracture unites. Management of these injuries is based on the location and nature of the fracture. Unstable fracture patterns include distal oblique fractures (B1), complete waist fractures (B2), proximal pole fractures (B3), transscaphoid perilunate dislocation (B4) and comminuted fractures (B5). Stable fracture patterns include those of the scaphoid tubercle (A1) and incomplete fractures through the scaphoid waist (A2). The Herbert Classification is the most common classification, which groups scaphoid fractures into stable (A) and unstable fractures (B). These fractures can be divided according to their location (proximal third waist or middle third distal third), fracture displacement (undisplaced or minimally displaced displaced) and fracture stability. When negative, the second line imaging is either magnetic resonance imaging or computed tomography scan: This is particularly valuable when considering return to sport in affected athletes. Clinically, this fracture can be difficult to diagnose and may not become visible until repeated scaphoid view radiographs are obtained. Sensitive examination findings include tenderness in the anatomical snuffbox, scaphoid tubercle and pain on longitudinal compression of the thumb. The scaphoid is at particular risk from sports involving high impact injuries to the wrist, such as football, rugby and basketball.Ĭlinicians should have a high index of suspicion in athletes presenting with post-traumatic pain on the radial aspect of the wrist or in the anatomical snuffbox region. These fractures usually arise from a fall onto a hyperextended wrist, resulting in longitudinal loading of the scaphoid and a subsequent failure of the dorsal cortex on compression. population and accounting for over 85% of all sport-related carpal bone fractures. The scaphoid is the most commonly fractured carpal bone in the athletic patient, occurring a rate of 0. Six studies recorded fracture union data: Union rate 97% (69/71) mean time to union 9.8 wk. Three studies reported on Percutaneous Screw Fixation, and five studies reported on Open Reduction Internal Fixation. ![]() For surgical management, RRS was 98% (81/83), and RTS was 7.3 wk. Four studies recorded fracture union data: Union rate 85% (47/55) mean time to union 14.0 wk. ![]() Three studies allowed to return to sport in cast, and four studies required completion of cast treatment prior to returning to sport. For conservative management, RRS was 90% (69/77), and the mean RTS was 9.6 wk. Seven studies reported on conservative management ( n = 77), and eight studies reported on surgical management ( n = 83). Eleven studies were included: Two randomised controlled trials, six retrospective cohort studies and three case series. ![]()
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