Scaphoid Nonunions.

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Abstract

[Indexed for MEDLINE] 3. J Am Acad Orthop Surg. 2023 Aug 1;31(15):e550-e560. doi: 10.5435/JAAOS-D-22-01210. Epub 2023 Jun 16. Update to Management of Acute Scaphoid Fractures. Li NY(1), Dennison DG, Shin AY, Pulos NA. Author information: (1)From the Department of Orthopaedic Surgery, Division of Hand Surgery, Duke University School of Medicine, Durham, NC (Li), and the Department of Orthopaedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN (Dennison, Shin, and Pulos). The scaphoid is the most commonly fractured carpal bone. With high clinical suspicion and negative radiographs, expedient evaluation by CT or MRI has been recommended. When treating nondisplaced or minimally displaced scaphoid waist and distal pole fractures, immobilization below the elbow without inclusion of the thumb is an option. Comparatively, early surgical intervention for nondisplaced or minimally displaced scaphoid waist fractures allows for quicker return of function, but with increased risk of surgical complications and no long-term outcomes differences compared with cast immobilization. For most patients with such fractures, consideration for aggressive conservative treatment involving 6 weeks of immobilization with CT assessment to guide the need for continued casting, surgical intervention, or mobilization is advocated. Determination of union is best done with a CT scan at 6 weeks and at least 50% continuous trabecular bridging across the fracture site deemed sufficient to begin mobilization. Nonsurgical and surgical management of scaphoid fractures requires a thorough understanding of fracture location, fracture characteristics, and patient-specific factors to provide the best healing opportunity of this notoriously difficult fracture and return the patient to full function. Copyright © 2023 by the American Academy of Orthopaedic Surgeons. DOI: 10.5435/JAAOS-D-22-01210