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The Impact of Time to Surgery on Outcomes for Operatively Managed Scaphoid Fractures
Hassan Siddiqui, BS
1, Kamal Shaik, BS
2, Daniel Nemirov, MD
3, Anthony Castro, BA
3, Chris Sun, BA
3; Asif M. Ilyas, MD, MBA
2,3(1)Sidney Kimmel Medical College, Philadelphia, PA, (2)Drexel University College of Medicine, Philadelphia, PA, (3)Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
Objectives: Scaphoid fractures are the most common carpal bone injury and are prone to complications such as nonunion and avascular necrosis due to their limited vascularity. While surgical fixation is widely accepted for displaced fractures and increasingly considered for nondisplaced ones. However, the effect of timing of surgery on fracture healing remains unclear. This study evaluates the impact of time to surgery on union rates, healing time, and complication risk in operatively treated scaphoid fractures, with the study hypothesis being that earlier time to surgery would yield a faster union rate.
Methods: A retrospective review was conducted on consecutive adult patients with isolated acute scaphoid fractures treated surgically by fellowship-trained hand surgeons from 2016 to 2020 at a single academic practice. Patients were categorized into three groups based on time from injury to surgery: <3 weeks, 3-6 weeks, and >6 weeks. Outcomes included fracture union, time to union, complications, and bone graft usage. Statistical analyses were performed to assess intergroup differences.
Results: The study cohort consisted of 148 patients. There were no significant differences amongst cohorts regarding preoperative demographics nor fracture characteristics. Union rates decreased with increasing time to surgery, with 100% union in cases treated within three weeks, 93.5% at three to six weeks, and 88.9% after six weeks (p = 0.014). Median time to union was similar across groups (95-111 days, p = 0.92). No differences in complications were seen between groups.
Conclusions: Early surgical fixation of scaphoid fractures (within three weeks) is associated with significantly higher union rates. However, time to union remains consistent among fractures that go on to achieve healing. These findings underscore the importance of timely intervention in optimizing outcomes for scaphoid fractures and support the development of expedited diagnostic and referral protocols.
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