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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2009 April;60(2):151-60
Evaluation and management of scaphoid fractures and non-unions
Balaram A. K., Bindra R. R.
Department of Orthopedic Surgery and Rehabilitation Loyola University Medical Center, Maywood, IL, USA
The management of scaphoid fractures and non-unions has evolved in response to patient specific treatments and improvements in technology. Diagnosis is more reliable with the use of magnetic resonance imaging and the cost of imaging when compared to unnecessary immobilizations has been shown to be equivalent. Closed treatment of scaphoid fractures continues to be a debatable topic in terms of length and type of immobilization. Although closed treatment of scaphoid fractures results in successful outcomes, surgery for non-displaced scaphoid fractures with internal fixation has become an accepted method of care in order to help patients to return to work or athletics. Improvements in surgical implants have allowed for percutaneous approaches to fracture fixation as well as increased compression across the fracture site. Non-unions of the scaphoid are being identified earlier and surgical fixation has been found to prevent the progression of wrist arthrosis usually associated with the scaphoid non-union advanced collapse wrist. Multiple techniques for vascularized bone grafts have been developed to address avascular necrosis with scaphoid non-union.