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The Journal of Bone and Joint Surgery 83:483 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.

Percutaneous Screw Fixation or Cast Immobilization for Nondisplaced Scaphoid Fractures

Charles D. Bond, MD, Alexander Y. Shin, MD, Mark T. McBride, MD and Khiem D. Dao, MD

Investigation performed at the Naval Medical Center San Diego, San Diego, California
Charles D. Bond, MD Rutherford Orthopaedics, 139 Dr. Henry Norris Drive, Rutherfordton, NC 28139
Alexander Y. Shin, MD Mark T. McBride, MD Khiem D. Dao, MD Division of Hand and Microsurgery, Department of Orthopaedic Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134-5000
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. The Chief, Bureau of Medicine and Surgery, Navy Department, Washington, DC, Clinical Investigation program, sponsored this study (no. S-96-023) as required by HSETCINST 600.41A.
The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, the Department of Defense, or the United States Government.

Background:

Nondisplaced scaphoid fractures treated with prolonged cast immobilization may result in temporary joint stiffness and muscle weakness in addition to a delay in return to sports or work. Fixation of scaphoid fractures with a percutaneous cannulated screw has resulted in a shorter time to union and to return to work or sports. The purpose of this prospective, randomized study was to compare cast immobilization with percutaneous cannulated screw fixation of nondisplaced scaphoid fractures with respect to time to radiographic union and to return to work.

Methods:

Twenty-five full-time military personnel with an acute nondisplaced fracture of the scaphoid waist consented to be randomized to either cast immobilization or fixation with a percutaneous cannulated Acutrak screw (Acumed, Beaverton, Oregon) for the purpose of this study. Time to fracture union, wrist motion, grip strength, and return to work as well as overall patient satisfaction at the time of a two-year follow-up were evaluated.

Results:

Eleven patients were randomized to percutaneous cannulated screw fixation, and fourteen were randomized to cast immobilization. The average time to fracture union in the screw fixation group was seven weeks compared with twelve weeks in the cast immobilization group (p = 0.0003). The average time until the patients returned to work was eight weeks compared with fifteen weeks in the cast immobilization group (p = 0.0001). There was no significant difference in the range of motion of the wrist or in grip strength at the two-year follow-up evaluation. Overall patient satisfaction was high in both groups.

Conclusions:

Percutaneous cannulated screw fixation of nondisplaced scaphoid fractures resulted in faster radiographic union and return to military duty compared with cast immobilization. The specific indications for and the risks and benefits of percutaneous screw fixation of such fractures must be determined in larger randomized, prospective studies.


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