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Acute Fractures of the Scaphoid

Dr. Ring is Instructor of Orthopaedic Surgery, Harvard Medical School, Boston, and Director of Research, Hand Surgery Service, Massachusetts General Hospital, Boston. Dr. Jupiter is Professor of Orthopaedic Surgery, Harvard Medical School, and Chief, Hand Surgery Service, Department of Orthopaedic Surgery, Massachusetts General Hospital. Dr. Herndon is Chairman, Partners Department of Orthopaedics, Massachusetts General Hospital.

Reprint requests: Dr. Ring, Department of Orthopaedic Surgery, Massachusetts General Hospital, ACC 525, 15 Parkman Street, Boston, MA 02114.

Nondisplaced fractures of the scaphoid heal with cast immobilization in most cases, but operative treatment is being offered with greater frequency to active patients as an approach to reduce the period of cast immobilization. Computed tomography is more useful for evaluating displacement than standard radiography. Displaced fractures are at greater risk for nonunion and malunion—both of which have been associated with the development of radiocarpal arthritis in long-term studies—and should therefore be treated operatively. Surgical treatment is also recommended for complex fractures (open fractures, perilunate fracture-dislocations, and scaphoid fractures associated with fracture of the distal radius), very proximal fractures, and fractures for which the diagnosis and treatment have been delayed. Operative treatment of fractures of the scaphoid has been simplified by the development of cannulated screws. Internal fixation of fractures of the scaphoid may offer some advantages, including earlier return to athletics or manual labor.

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