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Surgical Treatment of Scaphoid Fractures - Does Delayed Treatment Affect Union Rate?
Verena M. Schreiber, MD; Caiyan Zhang, MS; James J. Irrgang, PT, PhD, ATC, FAPTA; John R. Fowler, MD
University of Pittsburgh Medical Center, Pittsburgh, PA

Introduction: Diagnosis of scaphoid fractures is frequently delayed, which can alter the prognosis for union. Stable non-displaced fractures, if found late, take on average twice as long to heal in a cast as acute fractures. Unstable and displaced fractures have a lower likelihood of healing in a cast if treatment is belated. This has led to a trend in earlier operative fixation for subacute fractures. The purpose of this study was to determine if delayed surgical treatment of scaphoid fractures affects the union rate.

Materials & Methods: A retrospective chart and imaging review was conducted for adult patients who underwent operative scaphoid repair between 2000 and 2013. The time of presentation was divided into two categories: less than 6 weeks and 6 weeks or longer. Patients were typically evaluated post-operatively at 2 weeks, 6 weeks, and 3 months. Radiographs at follow-up visits were reviewed to determine fracture union. Analysis included comparing union rates with a group of patients who presented with acute scaphoid fractures.

Results: 94 patients matched the inclusion criteria (72 male, 22 female, mean age 30.7 14.5 years). Among these patients, 82 (87.23%) of them had healed while 12 patients (12.77%) had nonunion. There was no association between the healing status and 1) gender (p = 0.15), 2) side of injury (p = 0.19), and 3) whether the injury is related to polytrauma (p = 0.62).The healing status was significantly predicted by whether patients presented early or late. More specifically, the odds of having a scaphoid nonunion for a patient with delayed presentation were 5.13 times larger than the odds for a peer who underwent surgery less than 6 weeks of injury, with the 95% CI for the OR [1.05, 25.15]. Tobacco use was not related to prediction of wrist healing status, OR = .30, 95% CI [.08, 1.09] and neither was fixation method, OR = .38, 95% CI [.04, 4.01]; nor approach, OR = 2.64, 95% CI [.74, 9.47].

Conclusions: The results of this study demonstrate that there is suspicion for decreased union after surgical fixation of scaphoid fractures when diagnosis and treatment is delayed. It also provides evidence to emphasize early referral to specialists if any concern for scaphoid fracture is established.


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