Orthopaedic Surgery

Answer 3 Radiographs are the primary resource for assessing union within the first 12 weeks. Radiographs cannot accurately depict bone healing in the first 12 weeks after surgical procedures. Plain radiographs are unreliable and are often a source of error in assessing scaphoid union. The best tool for assessing union at 12 weeks is computed tomography scan.3 Proximal pole scaphoid fractures are more likely to end in avascular necrosis than middle third fractures because of the vascular anatomy; therefore, middle third fractures have a better prognosis for healing. For nondisplaced scaphoid fractures, closed reduction and percutaneous fixation are favored because they offer a high postsurgical union rate of 90% and can allow return to activity in 8 to 12 weeks or sooner.4 Open reduction and internal fixation are preferred for displaced fractures. In all cases, partial removal of the scaphoid is a last resort and is generally not performed for athletes.3 REFERENCES 3. Burge P. Closed cast treatment of scaphoid fractures. Hand Clin 2001;17:541-52. 4. Canale ST. Campbellšs operative orthopaedics. 10th ed. St. Louis: Mosby; 2002. Click here to return to the questions

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