The Journal of Bone and Joint Surgery (American) 82:633 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.
Displaced Scaphoid Fractures Treated with Open Reductio and Internal Fixation with a Cannulated Screw*
Thomas E. Trumble, M.D. ,
Mary Gilbert, M.A.,
Lorne W. Murray, B.S.,
Jeffery Smith, M.D. and
Wren V. McCallister, M.D.
Investigation performed at the University of Washington Medical
Center, Seattle, Washington
*No benefits in any form have been received or will be received
from a commercial party related directly or indirectly to the subject
of this article. No funds were received in support of this study.
Department of Orthopaedics, University of Washington Medical
Center, Box 356500, 1959 Pacific Street, Seattle, Washington 98195.
Background: This study was performed to
determine if the accuracy of screw placement was improved with use of
the Herbert-Whipple cannulated screw compared with use of the AO/ASIF
cannulated screw and also to evaluate the functional results in
patients with an acute displaced fracture of the waist of the scaphoid
treated with open reduction and internal fixation with a cannulated
screw.
Methods: We retrospectively reviewed the results
for thirty-five patients in whom an acute displaced fracture of
the waist of the scaphoid had been treated with internal fixation
with use of a cannulated screw. The patients were divided into two
groups; Group 1 consisted of nineteen patients managed with a 3.5-millimeter
cannulated AO/ASIF screw from 1990 through 1997, and Group 2 consisted
of sixteen patients managed with a Herbert-Whipple screw from 1993
through 1997.
Results: There were no clinical or radiographic
differences between the two groups. The average time to union (and
standard deviation), confirmed with tomography, was 4.2 ± 1.2 months for Group 1 and 4.0 ± 1.2
months for Group 2. Both screws significantly improved the alignment
of the scaphoid and decreased carpal collapse (p < 0.01). Importantly,
the use of either cannulated screw improved the height-to-length
ratio and the lateral intrascaphoid angle, which were correlated
with an increase in the range of motion of the wrist (r = 0.584
and 0.625). In addition, both screws allowed for accurate placement
in the central portion of the proximal pole. Regardless of the type
of screw used, the time to union increased with increasing age of
the patient (r = 0.665) and with increasing initial displacement
of the fracture (r = 0.541). Within both groups, the time to union
was longer for the patients who smoked (p < 0.01).
Conclusions: Within both groups, cannulated
screw fixation maintained the corrected fracture alignment and promoted
healing and return of function. Our study shows cannulated screws
to be a safe and effective method of treatment.
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