Scaphoid fractures: current treatments and techniques

Scaphoid fractures are among the most common fractures of the bones of the wrist and usually result from a forceful extension of the wrist. If the diagnosis cannot be established by clinical and radiographic examination, bone scans are recommended and are preferred over tomography or MRI, which are more expensive diagnostic procedures. Scaploid fractures should be classified as either undisplaced, stable or displaced, unstable. Nonsurgical treatment with cast immobilization (short arm-thumb spica cast) is recommended for stable fractures; however, there is increased interest in percutaneous screw (or pin) fixation. The recommended treatment for unstable scaphoid fractures is open reduction and screw fixation. Closed reduction and percutaneous screw or pin fixation can be considered in minimally displaced or reducible fractures, whereas open reduction is recommended for all other displaced fractures. The following treatment protocols are recommended: (1) bone scan or, if necessary, tomography for early diagnosis; (2) percutaneous screw fixation of nondisplaced or minimally displaced scaphoid fractures as an alternative to treatment with a thumb spica cast; (3) open reduction of displaced scaphoid fractures; (4) early mobilization of stable fractures after internal fixation; and (5) the possible use of a playing splint after athletic injuries when secure internal fixation is achieved.