Clinical analysis of Carpal Scaphoid Fracture / 대한정형외과학회잡지

ABSTRACT

Scaphoid fracture is the most common carpal bone fracture and its treatment is frequently delayed due to difficulties of diagnosis. Nonunions and avascular necrosis are commonly developed due to peculiar blood supply. Though most of the undisplaced fracture, diagnosed early, can be managed easily by plaster of Paris immobilization, many cases of delayed diagnosis, displaced fractures and nonunions are difficult to treat and its outcome is not uniform. Ruse reported good results by iliac bone graft via volar approach and several internal fixation methods are reported such as K-wire, compression screw, Herbert screws etc. Recently, many suthors advocated accurate anatomical reduction in fear of volar and dorsal intercalary segmental instability. We reviewed 30 cases of scaphoid fracture at the department of orthopedic surgery, Kyungpook national university hospital, from June, 1986 to April, 1989 and obtained the following results. l. Among 30 cases of scaphoid fractures, 27 cases(90 %) were males. 2. Twenty one cases(70%) were between second decade and third decade. 3. The fracture mechanism is hyperdorsiflexion of the wrist during slip down or fall down in 21 cases(70%). 4. Right side is 17 cases(57%) and left 13 cases. Middle 1/3 fracture occupies 24 cases(80%) in anatomical location. 5. Among 15 cases of the fresh fracture, 11 cases(93%) attained bone union by plaster pf Paris immobilization. 6. Among 18 cases of operation, 3 cases were acute transscaphoid perilunar dislocation(TSPD), 1 case was delayed TSPD, 5 were delayed unions and 9 were monunions. Operative methods were Herbert screw fixations in 8, Herbert screw fication with iliac bone graft in 4, Russe's bone grafts in 6 cases. 7. The results of the treatment were classified according to the bone union status and range of motion of the wrist. In operative treatment, excellent and good results were obtained in 6 and 11 cases respectively, poor result in 1 case. In conservative treatment, excellent and good results in 6 and 5 cases respectively, fair in 1 case.