Analysis of mid-term radiological and functional results of conservative versus surgical intervention in non-displaced and minimally displaced scaphoid fractures

Abstract

Aims: In patients with non-displaced or minimally displaced scaphoid fractures (Herbert and Fisher types A1-2, B1-3), we compared radiographic union time, functional outcomes, complication rates, and time to return to work between conservative treatment and percutaneous screw fixation. Methods: From 2013 to 2023, a study examined patients aged 18 to 65 who had recently undergone treatment at one large hospital for non-displaced or minimally displaced scaphoid fractures. Patients were divided into conservative and surgical (percutaneous fixation with headless compression screw) groups. The study looked at clinical and radiographic outcomes including as range of motion (ROM), grip strength, radiographic union, Visual Analog Scale (VAS), Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) scores, scaphotrapezoid arthritis, complication rates, and return-to-work time. The statistical significance level was set at p<0.05. Results: A total of 107 patients (average age 34.87 years; 58.9% male) were included, with a mean follow-up time of 15.8 months. The surgical group had significantly shorter radiographic union and return-to-work durations (p<0.05). ROM and grip strength were higher in the surgery group, though not statistically significant. The surgical group had considerably decreased Q-DASH and VAS scores three and six months after surgery, but not twelve months. There were no significant variations in rates of delayed union, nonunion, malunion, or scaphotrapezoid arthritis across the groups. Conclusion: Both treatment methods improved union rates in non-displaced or minimally displaced scaphoid fractures. Percutaneous fixation has been linked to faster fracture healing, quicker return to work, and improved early function. Functional outcomes remained similar one year later. Surgical intervention may be useful for young, energetic persons who require quick mobilization, but conservative therapy is a viable and cost-effective option for compliant patients.

Keywords

• Scaphoid fractures
• percutaneous fixation
• herbert and fisher classification

Nondeplase veya minimal deplase skafoid kırıklarında konservatif ve cerrahi müdahalelerin orta vadeli radyolojik ve fonksiyonel sonuçlarının analizi

Abstract

Amaç: Nondeplase veya minimal displase skafoid kırığı (Herbert ve Fisher tip A1–2, B1–3) olan hastalarda konservatif tedavi ile perkütan vida fiksasyonu yöntemlerinin radyografik kaynama süresi, fonksiyonel sonuçları, komplikasyon oranları ve işe dönüş süreleri açısından karşılaştırılması amaçlanmıştır. Yöntemler: Bu retrospektif çalışmada, 2013–2023 yılları arasında büyük bir hastanede nondeplase veya minimal deplase skafoid kırığı nedeniyle tedavi edilen 18–65 yaş arası hastalar incelendi. Hastalar konservatif tedavi veya cerrahi (Acutrak başsız kompresyon vidası ile perkütan fiksasyon) gruplarına ayrıldı. Klinik ve radyografik sonuçlar; hareket açıklığı (ROM), el kavrama gücü, radyografik kaynama süresi, Görsel Analog Skala (VAS), Q-DASH (Quick Disabilities of the Arm, Shoulder, and Hand) skorları, ST artriti, komplikasyon oranları ve işe dönüş süresi gibi parametrelerle değerlendirildi. İstatistiksel anlamlılık sınırı p < 0.05 olarak belirlendi. Bulgular: Toplamda 107 hasta (ortalama yaş 34.87 yıl; %58.9 erkek) çalışmaya dahil edildi. Ortalama takip süresi 15.8 aydı. Cerrahi grupta radyografik kaynama süresi ve işe dönüş süresi anlamlı derecede daha kısaydı (p < 0.05). Hareket açıklığı ve kavrama gücü cerrahi grupta daha yüksek olmakla birlikte istatistiksel olarak anlamlı değildi. Q-DASH ve VAS skorları cerrahi grupta 3. ve 6. aylarda anlamlı olarak daha düşüktü, ancak 12. ayda gruplar arasında fark yoktu. Gecikmiş kaynama, kaynamama, malunion ya da ST artriti oranlarında gruplar arasında anlamlı fark saptanmadı. Sonuç: Her iki tedavi yöntemi de nondeplase veya minimal deplase skafoid kırıklarında yüksek kaynama oranları sağlamaktadır. Perkütan fiksasyon, daha hızlı kırık iyileşmesi, daha erken işe dönüş ve erken dönem fonksiyonel avantajlar sunmaktadır. Ancak bir yıllık takipte fonksiyonel sonuçlar benzer düzeydedir. Cerrahi tedavi, erken mobilizasyona ihtiyaç duyan genç ve aktif hastalar için avantaj sağlarken, konservatif yaklaşım uyumlu hastalar için geçerli ve ekonomik bir alternatiftir.

Keywords

• Skafoid Kırıkları
• Perkütan Fiksasyon
• Herbert ve Fisher Sınıflandırması

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