The results of surgical treatment of scaphoid fractures

Objectives: To assess the result of the treatment of scaphoid fracture and associated pathologies.Matherial and Methods: In our study, 24 patients who were operated due to scaphoid fracture and associated injuries between 2004-2011 were evaluated. 18 patients had nonunion, 6 patients had acute fracture. In nonunion group 15 patients were treated with nonvascular greft application, 3 patients with proksimal row resection. 6 patients with acute fractures were trated with open reduction and internal fixation. All of the patients were male (n:24)). In the group treated with nonvascularized greft (n=15), 8 patients had proximal pole fracture and 7 patients had waist fracture. Avascular necrosis was seen in 40% of all patients. Avascular necrosis were determined in half of patients with proksimal pole and 28% of waist fracture group. Proximal row resection was applied to 2 patients with skafoid nonunion advanced kollaps and one due to the failure of nonvascularized greft and internal fixation postoperatively. In three of the six patients were operated for acute scaphoid fracture had perilunate dislocation and 1 patient had lunate dislocation also. Fractures and dislocations were treated with open reduction and internal fixation. Postop grip strength and range of motion were recorded. Functional results were assessed with MAYO wrist score and quick disabiliti arm shoulder and hand score systems.Results: In nonvascularized group 73% healing was seen at the end of 16 weeks. The mean value of preoperative quick disabliti arm shoulder and hand score was 30.8, postop quick disabiliti score was 14,6 and mean postoperative MAYO wrist score was 69,3 (medium). The MAYO wrist score of 3 patients was treated with proximal row resection was 60 (±20) and quick disabiliti arm shoulder and hand score value was 13,6 (±13.8). Both grip strength and range of motion were the 60 percent of the nonoperated side. Union could not be obtained one of the 6 patients were operated for acute scaphoid fracture. In this group, all patients with follow up intercarpal degeneration (n:3) were operated for fracture with dislocation.Conclusion: The results of nonvaskularize grafting and fixation of scaphoid nonunions despite the successful results in the presence of avascular necrosis of the proximal fragment is even worse. Because of the low complication rate and permission to the wrist joint movement, the proksimal row resection is a good option for the patients with intercarpal degenaration depends on scaphoid nonunion; especially whom does not have high expectations. The patients with transscaphoperilunate dislocation, open reduction and internal fixation must be applied at early period and patients must be informed about the potential intercarpal degeneration and range of motion restriction in the future.