Scaphoid plating for recalcitrant scaphoid fractures: a systematic review

Area of Science:

• Orthopedic Surgery
• Traumatology
• Evidence-Based Medicine

Background:

• Recalcitrant scaphoid fractures pose challenges in achieving union.
• Scaphoid plating is a surgical option, but its efficacy and complications require evaluation.

Purpose of the Study:

• To systematically review the outcomes of scaphoid plating for recalcitrant scaphoid fractures.
• To compare scaphoid plating with headless compression screws regarding union rates and complications.

Main Methods:

• Systematic review of studies from EMBASE, Pubmed, Cochrane, and MEDLINE.
• Inclusion of thirteen studies reporting on scaphoid plating outcomes.
• Analysis of bony union, complication rates, range of motion, grip strength, and return to work.

Main Results:

• Bony union was achieved in 72% to 100% of cases across eleven studies.
• Scaphoid plates showed no significant difference in union incidence compared to headless compression screws.
• Mean plate removal incidence was 21%, higher than typically reported for headless screws.
• Significant improvements in flexion-extension arc (119°), grip strength (14%), and patient-reported outcomes were observed.
• Eighty-six percent of participants returned to their previous work.

Conclusions:

• Scaphoid plating is effective for achieving bony union and functional recovery in recalcitrant scaphoid fractures.
• The higher rate of plate removal compared to headless compression screws is a notable consideration.
• Further comparative studies are warranted to optimize treatment strategies for scaphoid fractures.