Fracture de scaphoïde - ASSH 2014

Benefits of a double antirotation screw fixation performed with arthroscopy for scaphoid fractures: a prospective series of 9 cases

P.Croutzet, C. De Cheveigné, B. Ferreira, A. Gaston Nouvel
American Society for Surgery of the Hand – Boston, Septembre 2014

 

Hypothesis

Consolidation is the main problem of scaphoid fractures. Percutaneous fixations have demonstrated benefits on the one hand and wrist arthroscopy has improved reduction and has prevented osteosynthesis morbidity on the other hand.
Fixation is mostly performed with one cannulated screw and the screw’s compression is supposed to avoid rotation.

Despite these recent improvements, nonunions still occur and we consider this is partly due to persistent rotation mobility at the fracture site.
This prospective series proposes to assess a double screw fixation to maximize compression and avoid rotation, performed with arthroscopy in order to control reduction and to prevent fixation morbidity.

Method

Over a period of one year, 9 isolated recent (<3months) scaphoid fractures were operated on with double compression screws under wrist arthroscopy.
We used cannulated (Ø 2 mm) compression screws, a 1,9mm arthroscope with three portals : a midcarpal radial, a radiocarpal 3-4, and an occasional 2-3 instrumental portal.

A splint was kept for 3 weeks followed by an active/passive physiotherapy.
Physical examination and X-ray were performed after 3, 6 and 12 weeks, a CT-scan after 12 weeks.

Analysis criteria were:
- perioperative: ligament injuries, duration of surgery. -postoperative: pain, wrist motion (F/E° ; Inclinations ; P/S°), grasp strength, time off work and sports, radiographic analysis (reduction, ct-scan consolidation, secondary displacement).

Results

All patients were reviewed three times. Duration of surgery was 45 minutes (30-70), none scapho-lunate ligament injury was noticed. About strength and mobility:
- After 3 weeks: F/E : 70/60°, I°R/I°C 5°/20°, P/S 70°/75°, Grasp 30%
- After 6 weeks: F/E : 80/75°, I°R/I°C 10°/25, P/S 75°/85°, Grasp 65%
- After 12 weeks: F/E : 85/80°, I°R/I°C 10°/25, P/S 75°/85°, Grasp 90%

We noticed 9 anatomic reductions and consolidation in all cases after 12 weeks. Time off work was 3 weeks (0-7).

Conclusion

Functional mobility was regained after 6 weeks, accompanied by a good strength.
The double antirotation screw fixation with arthroscopy seems to be a reliable and efficient procedure for scaphoid fractures enabling rapid recovery and safe results.

Arthroscopic double-screw scaphoid is a reliable and an effective technique that provides a short convalescence with a lasting result.
We considered this procedure as pertinent enough to be used in certain recent scaphoid nonunions.

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