AAHS ASPN ASRM - 2013 Annual Meeting - American Association ...
AAHS ASPN ASRM - 2013 Annual Meeting - American Association ...
AAHS ASPN ASRM - 2013 Annual Meeting - American Association ...
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B. Operative Treatment<br />
12, 13<br />
1. Herbert & Fisher<br />
a. “New scaphoid screw”<br />
b. Volar approach<br />
c. 100% union rate in acute fractures<br />
2. Rettig & Kollias 12-23<br />
a. 12 athletes, acute waist scaphoid fx, ORIF with Herbert screw<br />
b. Avg union rate 90% by 9.8 weeks<br />
c. Return to sports in less than 6 weeks<br />
All volar approaches require division of volar carpal ligaments!!!<br />
III. Percutaneous Scaphoid Fixation<br />
A. Minimally invasive – avoids division of important volar carpal<br />
ligaments and excessive soft tissue dissection<br />
B. Indications<br />
1. High Performance Athlete<br />
2. “Critical need to return to work or activity”<br />
C. The Data –<br />
1. Nondisplaced scaphoid waist fractures<br />
a. Bond, Shin, McBride Dao3 1) Prospective randomized study – cast vs. percutaneous<br />
screw fixation (25 patients)<br />
2) Acute stable waist fractures<br />
3) Time to healing with surgery 7.09 weeks vs. 11.62<br />
weeks for cast (p=0.0003)<br />
4) Return to military duty paralleled healing time (p=0.0001)<br />
5) Minimal complications<br />
6) No nonunions or delayed unions<br />
b. Adolfsson, Lindau, Arner1 1) Multicenter, prospective, randomized<br />
2) 53 patients with undisplaced scaphoid waist fractures<br />
3) Percutaneous Acutrak screw vs. cast immobilization (short arm cast)<br />
4) No statistical difference between groups for rate of union and<br />
time to union (but radiographs not obtained at interval periods)<br />
5) Improved motion at 16 weeks for screw group<br />
6) No difference in grip strength<br />
7) Acute fixation with percutaneous screw allows early mobilization<br />
without adverse affect on fracture healing<br />
c. Yip, Wu, Chang, So 27<br />
1) 49 patients with scaphoid waist stable fracture<br />
2) volar percutaneous technique: AO screw or Alphatec screw<br />
3) Average time to fracture union 12 weeks<br />
4) 16 patients with trapezium erosion<br />
2. Displaced Scaphoid Waist Fractures – volar Percutaneous Technique<br />
a. Jeon, Oh, Park, Ihn, Kim14 1) 13 displaced waist fracture<br />
2) Volar, non-cannulated screw placement<br />
3) Union at 9.2 weeks, 100% union<br />
4) Return to work ranged from 1 day to 3 weeks<br />
5) One case RSD<br />
28
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