Incidence of ligamentous and other injuries associated with scaphoid fractures during arthroscopically assisted reduction and percutaneous fixation.

PURPOSE: The purpose of this study was to describe chondral/osteochondral and ligamentous injuries associated with scaphoid fractures treated with arthroscopically assisted reduction and percutaneous fixation.

METHODS

The study consisted of 8 patients with stable scaphoid fractures and 16 with unstable scaphoid fractures. The mean age was 32 +/- 14 years (range, 17 to 75 years). The arthroscopic findings were recorded, including intrinsic and extrinsic ligamentous injuries as well as osteochondral injuries. Percutaneous screw fixation through a dorsal approach was performed. In all patients with associated soft-tissue injuries, a short-arm thumb spica cast was used for a 3- to 6-week period. Follow-up included clinical evaluation with the Mayo Modified Wrist Score and plain radiographs. The mean follow-up time was 27 +/- 16 months, with a minimum of 1 year. The mean healing time was 7 +/- 4 weeks (range, 6 to 24 weeks).

RESULTS

Associated soft-tissue and/or chondral/osteochondral injuries were diagnosed arthroscopically in 15 of 24 cases in this series. The result was scored as good or excellent in 23 patients and poor in 1. Complications included 1 case with partial necrosis of the proximal scaphoid pole and 2 patients with loss of wrist flexion and grip strength that improved after hardware removal.

CONCLUSIONS

In this series, 15 of 24 patients with acute scaphoid fractures presented with associated ligamentous and/or chondral/osteochondral injuries.

LEVEL OF EVIDENCE: Level IV, therapeutic case series.