Slideshow
-
Figure 1. Anteroposterior radiograph of the left wrist.
-
Figure 2. Lateral radiograph of the left wrist.
-
Figure 3. Scaphoid view radiograph of the left wrist.
A 14-year-old presents with pain in the left wrist after a fall. He was playing basketball 2 days prior and landed on the wrist while diving for a ball. Anteroposterior, lateral, and scaphoid view radiographs (Figures 1, 2, and 3) show a nondisplaced scaphoid fracture.
Which statement is true regarding treatment of this fracture?
Submit your diagnosis to see full explanation.
The scaphoid bone is the most commonly fractured carpal bone. The scaphoid has a unique retrograde blood supply that causes an increased risk for nonunion of the fracture and avascular necrosis (AVN). Surgical treatment is almost always recommended for displaced scaphoid fractures. Treatment of nondisplaced and minimally displaced (<1 mm) fractures is more controversial. Time to union, time to return to work, final hand strength, and patient satisfaction all favor surgical treatment. Range of motion, pain, and complications are similar between surgical and nonsurgical treatments. Surgical treatment, however, may result in an increased risk for osteoarthritis. With all factors considered, there is no clear superior outcome between operative and nonoperative treatment. The union rate for cast-treated scaphoid fractures displaced <1 mm is 90%; therefore, immobilization is generally the most common treatment method. Treatment of a nondisplaced wrist fracture in a 15-year-old would favor cast treatment for a period of 3 months. Surgical treatment is usually considered more in patients who cannot tolerate a 3-month duration of immobilization.1,2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).
References
1. Buijze G. Doornberg J, Ham JS, Ring D, Bhandari M, Poolman RW. Surgical compared with conservative treatment for acute nondisplaced or minimally displaced scaphoid fractures: a systematic review and meta-analysis of randomized controlled trials. J Bone joint Surg Am. 2010;92(6):1534-1544.
2. Vinnars B, Pietreanu M, Bodestedt A, Ekenstam F, Gerdin B. Nonoperative compared with operative treatment of acute scaphoid fractures: a randomized clinical trial.J Bone Joint Surg Am. 2008;90(6):1176-1185.
QUESTION
