Incidence of ligamentous and other injuries associated with scaphoid fractures during arthroscopically assisted reduction and percutaneous fixation.

摘要

PURPOSE: The purpose of this study was to describe chondral/osteochondral and ligamentous injuries associated with scaphoid fractures treated with arthroscopically assisted reduction and percutaneous fixation. METHODS: The study consisted of 8 patients with stable scaphoid fractures and 16 with unstable scaphoid fractures. The mean age was 32 +/- 14 years (range, 17 to 75 years). The arthroscopic findings were recorded, including intrinsic and extrinsic ligamentous injuries as well as osteochondral injuries. Percutaneous screw fixation through a dorsal approach was performed. In all patients with associated soft-tissue injuries, a short-arm thumb spica cast was used for a 3- to 6-week period. Follow-up included clinical evaluation with the Mayo Modified Wrist Score and plain radiographs. The mean follow-up time was 27 +/- 16 months, with a minimum of 1 year. The mean healing time was 7 +/- 4 weeks (range, 6 to 24 weeks). RESULTS: Associated soft-tissue and/or chondral/osteochondral injuries were diagnosed arthroscopically in 15 of 24 cases in this series. The result was scored as good or excellent in 23 patients and poor in 1. Complications included 1 case with partial necrosis of the proximal scaphoid pole and 2 patients with loss of wrist flexion and grip strength that improved after hardware removal. CONCLUSIONS: In this series, 15 of 24 patients with acute scaphoid fractures presented with associated ligamentous and/or chondral/osteochondral injuries. LEVEL OF EVIDENCE: Level IV, therapeutic case series.