الفهرس 
Mandatory basic scienceOnly 14 pages are availabe for public view
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Abstract
Scaphoid bone fracture is the most common fracture of the
carpal bones accounting for about 60% of all carpal bone fractures.
Clinical evaluation and management of scaphoid fractures depends on
its classification. Complete fracture waist of scaphoid classified as B2
according to Herbert classification can be managed by conservative or
operative management.
Various procedures may be used to restore alignment and
anatomic fracture reduction to preserve intercarpal joint motion. These
procedures may be volar or dorsal, open or percutaneous.
Open volar approach to the scaphoid is most often utilized for
waist, distal third fractures and for correction of a flexed scaphoid
deformity. The entire volar surface of the scaphoid can be visualized
allowing reduction confirmation which is useful in cases of volar bone
loss, comminution, or the need to correct a scaphoid humpback
deformity.
Percutaneous approaches have been used as a method to
decrease soft tissue injuries to the radiocarpal ligaments and dorsal
capsular structures. It also limits the damage to the surrounding blood
supply that theoretically may improve fracture union.
Decreased surgical trauma and improved fracture healing
ultimately led authors to advocate earlier return to work in patients
treated with these less invasive approaches.
So, percutaneous techniques have been used as less invasive
surgical approaches that may have an added benefit in the nondisplaced fractures meanwhile displaced and unstable fractures should
Summary
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be approached with a volar or dorsal open technique to achieve and
confirm an anatomic reduction before screw placement.
The aim of this study was to compare between volar open
approach and volar percutaneous fixation by Herbert screw for recent
scaphoid waist fractures.
A prospective study on 34 patients with recent scaphoid
fractures underwent open reduction and internal fixation or
percutaneous fixation by Herbert screw in the Department of
orthopaedic surgery in Menoufia University Hospital and Elamrya
General Hospital with equal distribution of patients between the two
procedures.
The inclusion criteria were: Adult age group (18-60 years old),
isolated non-comminuted scaphoid middle third waist fracture, recent
fractures within 3 weeks, closed fractures.
The exclusion criteria were: old and non-united scaphoid
fractures, concomitant injuries to the ipsilateral hand, wrist or forearm,
neurovascular problems and compartmental syndrome, open fractures
and any pathological wrist condition as (osteoarthritis, stiff wrist,
Kienböck’s Disease).
They were evaluated clinically and radiologically which was
made by plain x-rays in three views (postero-anterior view, lateral
view and scaphoid view) pre-operative and post-operative.
The mean age was 33.65 ± 9.14 (range, 20 - 51) years and 29.24
± 7.21 (range, 18 - 42) years in group A and B respectively. All
patients in this study were males except two female patients who were
treated using volar percutaneous fixation. The main mechanism of
injury was falling down on outstretched hand with 29 patients divided
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as 15 patients in group A and 14 patients in group B. Ten patients
were injured in their non-dominant hand with four patients in group A
and six patients in group B. On the other hand, 13 patients in the
group A were injured in their dominant hand with 10 patients in group
B. Nineteen patients were smokers with 10 patients in group A and
nine patients in group B. Twelve patients in the group A were right
sided while five patients were left sided. In group B, nine patients
were right sided while eight patients were left sided. Fracture union
was not affected by patient age, gender, mechanism of injury,
domination, smoking or side.
The mean postoperative pain score according to MMWS for
group A was 16.76 ± 4.98 (range, 10 - 25) but for group B it was
18.24 ± 3.03 (range, 15 - 25). The mean postoperative range of motion
score according to MMWS for group A was 15.88 ± 5.07 (range, 10 -
20) but for group B it was 19.41 ± 4.96 (range, 10 - 25). The mean
postoperative hand grip strength score according to MMWS for group
A was 15.88 ± 4.76 (range, 10 - 25) but for group B it was 17.94 ±
4.70 (range, 15 - 25). The mean postoperative time from injury to
surgery for group A was 7.41 ± 5.53 (range, 1 - 18) days but for group
B it was 5.29 ± 3.44 (range, 1 - 14) days. The mean postoperative
radiological fracture union score according to scaphoid fracture union
grading scale for group A was 2.24 ± 0.75 (range, 1 - 3) but for group
B it was 1.53 ± 0.72 (range, 1 - 3). The mean postoperative patient
satisfaction score according to MMWS for group A was 21.18 ± 3.76
(range, 10 - 25) but for group B it was 21.76 ± 2.46 (range, 20 - 25).
The mean postoperative final score according to MMWS for group A
was 69.71 ± 15.26 (range, 40 - 90) but for group B it was 77.35 ±
10.33 (range, 60 - 95).
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At the end of postoperative follow up our results showed that
both procedures are reliable options to decrease the incidence of
scaphoid nonunion/malunion with residual carpal instability; however
percutaneous fixation technique leads to early union and early return
to functional activity with lesser complications as compared to open
technique.
Postoperative complications were few. There were two patients
with wound dehiscence on the volar open reduction and internal
fixation, three patients with superficial infection on the open surgical
wound, one patient in each procedure showed Herbert screw
protrusion and lastly twelve patients showed postoperative wrist joint
stiffness with eight of them had done open reduction and internal
fixation and four patients had done volar percutaneous fixation.