TITLE:
Functional outcome in conservatively treated non-displaced scaphoid fractures
AUTHORS:
Tessa Drijkoningen, Frank J. P. Beeres, Roderick H. van Leerdam, Daan Ootes, Diana C. Grootendorst, Marleen Otoide-Vree, Steven J. Rhemrev
KEYWORDS:
DASH; Scaphoid Fracture; Os scaphoideum; Hand Trauma; Conservative Treatment
JOURNAL NAME:
Open Journal of Clinical Diagnostics,
Vol.2 No.4,
December
11,
2012
ABSTRACT: Purpose: This study evaluated the functional outcome after conservative treatment of non-displaced scaphoid fractures using an international validated outcome scale (DASH). Methods and materials: Between 2005 and 2010, 60 patients with a non-displaced scaphoid fracture were included. When a patient visited the emergency department and was clinically suspected of a scaphoid fracture radiography was performed. If no fracture was diagnosed with this modality a CT or MRI-scan both in combination with bonescintigraphy was performed. Patients with scaphoid fractures diagnosed with CT/MRI and bonescintigraphy were treated with a six-week scaphoid forearm cast. Within 1 year after cast removal patients filled in the DASH questionnaire. Results: Sixty (80%) patients returned the DASH questionnaire at 12 months after treatment. Thirty-eight (63.3%) were male and the mean age was 35 (range 11 - 83). Forty-four (73.3%) patients had a mid-waist fracture of the scaphoid, 13 (21.7%) had a fracture of the distal pole and three (0.05%) had a proximal fracture. Median DASH score at one year after the trauma was 6 (range 3 - 15) for patients with a distal pole fracture and 5 (range 0 - 21.5) for mid-waist fractures (p = 0.7, table 2). For the three patients with a proximal scaphoid fracture the DASH scores appeared higher and were 83, 82 and 30 respectively. Conclusion: Conservative treatment for six weeks with a below the elbow cast is sufficient for the majority of patients with an occult distal or mid-waist scaphoid fracture and results in a good functional outcome according to the DASH questionnaire.