8 9 If at least 50% union was not achieved with casting alone, the fracture was classified as having failed cast treatment. 8 The fracture was classified as ‘united’ if union was determined to be 50% or greater. We determined the percentage union for each scan based on the method described by Singh et al. 7 A single observer reviewed all CT scans obtained for each fracture. Details of the CT protocol have been previously published. Clinical data collected included age, history of diabetes, any other significant past medical history, smoking history, length and reason for treatment delay.Īll patients received a CT scan of their scaphoid at initial presentation to our clinic and at ∼6 weeks afterwards to assess union. Each subject's health record, X-rays and CT scanswere reviewed to determine injury and treatment details. All fractures were initially treated with a short arm thumb spica cast. The date of injury was determined based on patient history and a review of the health record (i.e., initial emergency room visits in cases where initial X-rays were incorrectly interpreted as normal). The purpose of this study is to report union rates and union times for sub-acute scaphoid fractures that have been followed with serial CT scans and determine the following: 2 3 4 5 6 Previous limitations in imaging (i.e., plain radiographs) may have contributed to under-estimation of actual healing and may have limited the ability to identify factors that might differentiate those scaphoid fractures that are likely to heal from those most likely to become persistent non-unions as xrays have been shown to be unreliable in assessing scaphoid fractures. The few reports that do exist have small sample sizes and use only X-ray to evaluate the scaphoid, a method that is considered unreliable. Unfortunately, there is little literature investigating the outcomes of scaphoid fractures that are initially missed. 2 3 Reports indicate that for certain fractures presenting in a delayed manner (stable, middle-third), union can be expected with cast treatment, although it may take twice as long 3. If a scaphoid fracture is not identified in a timely fashion and is not treated for several weeks, the risk of non-union or delayed union increases. 1 However, scaphoid fractures can be difficult to diagnose and are often missed on initial X-rays. When a scaphoid fracture is diagnosed and treated in a timely fashion, excellent results can be expected with either cast immobilization and/or open reduction internal fixation (ORIF). The expected time frame for union with cast treatment is shorter than previously reported. Exclusion of these cases resulted in a 96% union rate (23/24).Ĭonclusion Subacute scaphoid fractures (presenting within 6 months from injury) can be expected to successfully heal with casting alone, even if the initial diagnosis is delayed. Diabetes, comminution and a humpback deformity increased the non-union risk in this cohort. The mean casting time was 11 (waist) and 14 (proximal pole) weeks with a union rate of 82% (23/28). There were 20 waist, 7 proximal and 1 distal pole fracture. Results There were 20 males and 8 females, with a mean age of 30, treated with casting alone. Each subject's health record, CT scans and X-rays were retrospectively reviewed. Methods All isolated sub-acute scaphoid fractures that presented at our institution between 20 were identified. Questions 1) What are the expected union rates for subacute scaphoid fractures? 2) What are the expected union times for subacute scaphoid fractures? 3) Is it worth trialing a period of cast immobilization for these patients? Background The purpose of this study is to evaluate outcomes (report union rates and times based on CT) for subacute scaphoid fractures, defined as those presenting between 6 weeks and 6 months from injury.
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