[Percutaneous screw fixation of non- or minimally displaced scaphoid fractures].

OBJECTIVE

Providing stability and reduction of the period of immobilisation of non- or minimally displaced scaphoid fractures using a minimally invasive technique.

INDICATIONS: Scaphoid fractures of the types A2, B1 and B2 (Herbert's classification) with no or minimal displacement, along with a patient's request for early functional treatment.

CONTRAINDICATIONS: Relative contraindications: significant dislocation of the fracture, scaphoid cyst or a too proximal fracture, concomitant fractures of the wrist. Absolute contraindications: pseudoarthrosis, luxation fractures.

SURGICAL TECHNIQUE: Minimally invasive percutaneous screw fixation using a double threaded screw.

POSTOPERATIVE MANAGEMENT: Postoperative immobilisation in a plaster cast with a thumb inlay for 1-3 weeks until swelling and pain subside. Followed by active physiotherapeutic exercise, however no pressure on the hand for 6 weeks after surgery.

RESULTS

Seventy patients with a non- or a minimally displaced scaphoid fracture were treated between 2005 and 2011. We used percutaneous screw fixation as the therapy technique. A total of 57 patients (81%) presented for follow-up. Four patients (5.7%) had an unhealed fracture 6 months postsurgery confirmed. One patient needed revision surgery because of a screw that was too long. None of the patients had a postsurgical infection, haematoma or a complex regional pain syndrome. Smoking and putting pressure on the hand too early have been identified as possible risk factors for the unhealed fractures.