[Percutaneous osteosynthesis of scaphoid fractures: preliminary results]

To evaluate the results of percutaneous osteosynthesis of scaphoid fractures and to verify whether this approach is more effective than conservative treatment.

A total of 25 patients were treated by percutaneous osteosynthesis at the Emergency and Accident Department of the University Hospital in Olomouc from March 1, 2002, till March 31, 2003. According to the Herbert classification, five had type A2 fractures, four had type B1 and 16 had type B2 fractures. The surgery was performed at 20.6 days on average after injury. HBS screw (Martin) fixation was used in 22 patients, a 3.5 mm cortical screw and a 4.0 mm cancellous bone screw (Poldi 5 set, Kladno, CZ) were inserted in one and two patients, respectively. The wrist was immobilized with a brace in 11 patients. After a short hospitalization, the patients were referred to an out-patient department for follow-up.

We evaluated the duration of postoperative immobilization, necessity to initiate assisted rehabilitation, length of follow-up at the out-patient department and the functional outcome. The control group comprised of 43 patients who were treated between March 1999 and December 2001. Only patients with type A, B1 or B2 scaphoid fractures managed conservatively were included. Nine patients were excluded because, during treatment, they were converted to conventional open osteosynthesis through the palmar approach.

In the study group, the average postoperative immobilization with a brace was 17 days; assisted rehabilitation was initiated in 50% of the patients and resulted in excellent functional outcomes; the average follow-up was 10.3 weeks. In one patient, the fractured scaphoid failed to heal. In the control group, the average postoperative immobilization was 7.5 weeks; assisted rehabilitation was started in 53% of the patients and 23% reported persistent complaints; the average follow-up was 11.4 weeks.

To achieve a good outcome of percutaneous osteosynthesis of a fractured scaphoid, it is important to make a precise diagnosis based on CT scan. This approach is suitable for type A2, B1 and B2 fractures. A good outcome of surgery depends on the correct insertion of a screw among fragments in order to achieve adequate compression among fragments. The necessity of postoperative immobilization and its manner and duration are current issues of discussion.

Our preliminary results show that, in indicated fractures types, the percutaneous osteosynthesis of a fractured scaphoid provides better functional outcomes than conservative treatment.