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Practice Patterns In The Management Of Common Scaphoid Injuries
Matthew Curran, MD1; Kenneth Faber, MD, MPHE, FRCSC2; Lisa Korus, MD, MPH, FRCSC1
1University of Alberta, Edmonton, AB, Canada; 2University of Western Ontario, London, ON, Canada

Purpose: To determine the current practices among Canadian hand surgeons for scaphoid injuries and potential determinants of these practices.
Methods: A survey consisting of 4 demographic questions and 11 management questions was constructed. Canadian hand surgeons were identified from registered databases. Potential participants were contacted through email with a link to the survey. A follow-up email was sent 4 weeks later. Frequencies of responses were collected and analyzed. A multinomial regression analysis was completed to determine any relationship between demographic data and operative choices. All data was analyzed using SPSS version 22.
Results: 76 surgeons responded to the survey giving a response rate of 20%. Surgeons having completed a Plastic Surgery fellowship in hand surgery in Canada were the most common. Surgeons practiced for an average of 15.2 years and performed greater than 20 operative wrist cases per year. Conservative therapy with a below elbow cast was the most common therapy for non-displaced scaphoid fractures. Scaphoid nonunions were most commonly treated with either a distal radius cancellous graft or iliac corticocancellous graft, depending on the presence of a humpback deformity. For patients with avascular necrosis regardless of location, vascularized distal radius was most frequently chosen. Acute SLD was treated with direct repair and capsulodesis while chronic SLD was treated either conservatively with eventual salvage or Brunelli procedure depending on symptoms Multinomial logistic analysis revealed no association between demographic questions and the operation performed.
Conclusions: Treatment of scaphoid fractures was most likely to be conservative, regardless of location. Strategies varied for scaphoid non union, avascular necrosis, and scapholunate injuries. No association was demonstrated with treatment choices and training location, specialty, number of cases or time in practice. While response rate was lower than anticipated this can be rationalized as a selection bias from including professional groups that would appreciably increase the number of surgeons participating but not the number of wrist surgeons.
Learning Objectives: Participants will be able to identify the most frequently performed management strategies for scaphoid injuries.


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