Long-Term Outcomes After Distal Scaphoid Fractures: A 10-Year Follow-Up

J Hand Surg Am. 2017 Nov;42(11):927.e1-927.e7. doi: 10.1016/j.jhsa.2017.06.016. Epub 2017 Jul 18.

Abstract

Purpose: The aim of this study was to evaluate the functional, clinical, and radiological outcome 10 years after distal scaphoid fractures.

Methods: From a prospective epidemiological study on posttraumatic radial-sided wrist pain, we evaluated 41 cases of distal scaphoid fractures. All cases had been treated nonsurgically in a thumb spica cast. Patients were examined using radiographs, magnetic resonance imaging and computed tomography at the time of injury and with computed tomography after a median of 10 years (range, 8-11 years). Fractures were classified according to a modified Prosser classification system. The primary outcome was assessment of self-reported function using Disabilities of the Arm, Shoulder, and Hand (DASH) and Patient-Reported Wrist Evaluation (PRWE). Secondary outcomes were clinical status (range of motion and grip and pinch strength) and to evaluate fracture healing and arthritis in the scaphotrapezium-trapezoid (STT) joint.

Results: Functional impairment and pain scores at follow-up were low: median DASH score 2, median PRWE 0, and median visual analog scale (VAS) pain score 0. We found no impairment in range of motion or strength. We found 26 type I fractures, 12 type IIA, 1 type IIC, and 2 type IV. There was 1 asymptomatic nonunion in a type I fracture. Computed tomography revealed arthritis in the STT joint in 7 out of 41 wrists, none of which caused clinical symptoms.

Conclusions: From an 8- to 11-year perspective, patients with distal scaphoid fractures report normal self-assessed hand function as well as good wrist motion and strength. The risk for development of posttraumatic STT arthritis was low.

Type of study/level of evidence: Prognostic II.

Keywords: Arthritis; CT; classification; outcome; scaphoid fracture.

Publication types

  • Evaluation Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Carpal Joints / injuries*
  • Casts, Surgical
  • Child
  • Cohort Studies
  • Conservative Treatment
  • Female
  • Fracture Fixation, Internal / methods
  • Fracture Healing / physiology*
  • Fractures, Bone / diagnostic imaging*
  • Fractures, Bone / therapy*
  • Humans
  • Injury Severity Score
  • Magnetic Resonance Imaging / methods
  • Male
  • Middle Aged
  • Observer Variation
  • Pain Measurement
  • Range of Motion, Articular / physiology
  • Recovery of Function
  • Retrospective Studies
  • Risk Assessment
  • Scaphoid Bone / diagnostic imaging
  • Scaphoid Bone / injuries*
  • Scaphoid Bone / surgery
  • Statistics, Nonparametric
  • Time
  • Tomography, X-Ray Computed / methods
  • Young Adult