Treatment of acute scaphoid fractures in the athlete

Scaphoid fractures in athletes can be very disabling and may limit successful and early return to play. Typically, the mechanism of injury is a fall onto an outstretched hand or a direct blow; the patient will present with swelling, limited motion, and snuffbox tenderness. Multiple-view plain images will very often reveal the diagnosis. In addition, diagnostic modalities such as CT scanning and MRI are helpful in better defining the architecture of the fracture and vascularity of the scaphoid, and diagnosing occult fractures. Early and accurate diagnosis is critical to help ensure appropriate treatment and optimal outcome. Traditional treatment of stable nondisplaced fractures remains cast immobilization. However, if early return to play is desired operative fixation may be warranted. For nondisplaced fractures operative techniques include open reduction and internal fixation (ORIF), and percutaneous fixation through a dorsal or volar approach. Arthroscopy can be used as an adjunct to the percutaneous technique. For displaced fractures, the preferred technique remains ORIF through either a volar or dorsal approach. Considerations in treatment type are based on the stability and location of the fracture as well as patient issues such as compliance and the need for return to play. With appropriate diagnosis and individualization of treatment, scaphoid fractures can be successfully managed in most athletes with few or no long-term sequelae.