Scaphoid Fractures

Division of Orthopedic Surgery, Department of Surgery, Far Eastern Memorial Hospital; and Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei. Received: 28 October 1999. Revised: 26 November 1999. Accepted: 1 February 2000. Reprint requests and correspondence to: Dr. Sheng-Mou Hou, Department of Orthopedic Surgery, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan. Simultaneous fractures of the distal radius and scaphoid are uncommon. The reported frequency has varied from 0.7% to 6.5% in cases of isolated fractures of each bone [1–3]. Techniques currently in use for fixation of the distal radius include casting, pin-in-cast, and external fixation with or without pinning, while those used for fixation of the scaphoid include thumb spica cast, percutaneous pinning to open reduction, and screw fixation [2–6]. Some authors have suggested that cast or splint immobilization is adequate for scaphoid fractures [3, 5], while others have suggested that fixation of the scaphoid before reduction of the distal radius is needed to prevent distraction of the scaphoid, which may induce nonunion [4, 6]. The purpose of this study was to review the results in patients with ipsilateral fractures of the distal radius and scaphoid treated at National Taiwan University Hospital from 1987 through 1998. Abstract: Simultaneous fractures of the distal radius and scaphoid are uncommon. Previous reports have outlined a variety of treatment methods for this condition. We describe the results in eight patients with simultaneous fractures of the distal radius and scaphoid, who were treated at National Taiwan University Hospital from 1987 to 1998. Treatments for the distal radius fractures included pin-in-cast in one patient, casting in one, external fixation in one, external fixation after pinning in three, and open reduction with internal fixation in two. All scaphoid fractures occurred at the scaphoid waist, and were treated with long-arm thumb spica in three patients, Herbert screw fixation in two, and percutaneous pinning in three. All of the fractures united, and none of the patients developed scaphoid avascular necrosis. One patient suffered from superficial radial nerve injury during external fixation. The functional results of the wrist were good in five patients and fair in three. To prevent the possible over-distraction of the scaphoid fracture, fixation of the scaphoid should be performed if a distraction force is to be applied during the treatment of the distal radius fracture. If no distraction force is to be applied, a thumb spica may provide adequate fixation for the scaphoid fracture.