Our Summary
This research paper is discussing the best way to treat a certain type of wrist fracture called a scaphoid waist fracture. The debate is whether to use one screw, two screws, or a special plate to fix the broken bone. Studies on the strength and stability of these different methods suggest that using two screws might be the best option. This might even allow the patient to start moving and strengthening their wrist sooner. Plus, some recent studies have shown that using two screws makes it more likely that the fracture will heal properly. The researchers’ own experience also supports this idea, as they have seen high success rates and few repeat surgeries when using two screws. However, they also note that more definitive clinical data is needed.
FAQs
- What are the different fixation strategies for scaphoid waist fractures?
- What advantages does a 2-screw fixation hold over other methods for scaphoid waist fractures?
- How effective has 2-screw fixation been in treating acute waist fractures and nonunions based on recent studies and experiences?
Doctor’s Tip
A doctor may advise a patient undergoing scaphoid fracture surgery to consider 2-screw fixation as it has been shown to have better biomechanical stability and potentially higher union rates. This may allow for earlier range of motion and strengthening post-surgery. It is important to discuss the best fixation strategy with your surgeon to ensure the best outcomes.
Suitable For
Patients who are typically recommended scaphoid fracture surgery are those with acute scaphoid waist fractures that are displaced or unstable, as well as those with nonunion of the scaphoid. Surgery is often recommended for patients who have failed conservative treatment or have a high risk of nonunion due to factors such as smoking, poor vascular supply, or delayed presentation. Additionally, patients who require early return to function, such as athletes or manual laborers, may also be candidates for surgery to expedite healing and rehabilitation.
Timeline
Before scaphoid fracture surgery:
- Patient experiences pain, swelling, and limited range of motion in the wrist
- X-rays and possibly MRI are taken to diagnose the fracture
- Patient may be placed in a cast or splint to immobilize the wrist and prevent further injury
- Patient undergoes pre-operative assessments and consultations with the surgeon
After scaphoid fracture surgery:
- Patient undergoes surgery to fixate the fracture using 2 screws or a scaphoid plate
- Patient is placed in a cast or splint for immobilization post-surgery
- Patient undergoes physical therapy and rehabilitation to regain strength and range of motion in the wrist
- Follow-up appointments with the surgeon to monitor healing progress and remove any hardware if necessary
- Patient gradually resumes normal activities and may experience improved wrist function and pain relief
What to Ask Your Doctor
- What are the risks and potential complications associated with scaphoid fracture surgery?
- What is the success rate of 2-screw fixation compared to other fixation methods for scaphoid waist fractures?
- How soon after surgery can I start range of motion and strengthening exercises?
- What is the expected recovery time and rehabilitation process following scaphoid fracture surgery?
- Will I need to wear a cast or splint after surgery, and for how long?
- What is the likelihood of developing a nonunion or needing a revision surgery after 2-screw fixation?
- What are the long-term implications of having a scaphoid fracture and undergoing surgery?
- Are there any specific restrictions or precautions I should follow during the healing process?
- How frequently will I need to follow up with you after surgery for monitoring and evaluation?
- Are there any alternative treatment options for scaphoid fracture that I should consider or be aware of?
Reference
Authors: Yildirim B, Deal DN, Chhabra AB. Journal: J Hand Surg Am. 2020 Aug;45(8):783.e1-783.e4. doi: 10.1016/j.jhsa.2020.03.013. Epub 2020 Apr 20. PMID: 32327338