Treatment Options, Return to Play, and Functional Performance after Operatively and Non-operatively Managed Acute Scaphoid Fractures

Abstract

Purpose of review: Scaphoid fractures are commonly encountered injuries in the athletic population. Conservative management is pursued for incomplete fractures and those involving the distal pole. Operative management is indicated for displaced fractures, unstable fractures, and those involving the proximal pole. Complete non-displaced scaphoid waist fractures can be treated operatively or non-operatively based on patient and surgeon preference. The purpose of this article is to discuss the treatment, rehabilitation, and return to play guidelines for scaphoid injuries.

Recent findings: CT scan is critically important to determine fracture displacement (which influences treatment choices) and healing (which influences return to activity determination). Nondisplaced scaphoid waist fractures can be treated with casting with 99.4% healing rate. Surgical treatment can hasten return to activities; newer surgical constructs have been suggested including dual screw fixation, plating, and staples. Outcomes of scaphoid fractures are generally favorable, as long as the selected treatment achieves a united, well-aligned scaphoid. In the athletic population specifically, there are high return to play rates and functional performances seen after these injuries. Each athlete is unique with regard to chosen sport, level of play, fracture type, and timing of the injury. Treatment options and return-to-play must be determined in a case-by-case manner to ensure an optimal clinical outcome.

Keywords: Athlete; Fracture; Return to play; Scaphoid.

Fig. 1

A PA view of an uninjured wrist with the wrist positioned in ulnar deviation, otherwise known as a scaphoid view. B Similar view in a patient with a scaphoid waist fracture and concomitant distal radius fracture

Fig. 2

A Lateral view radiograph of an uninjured wrist. The scapholunate (SL) angle is drawn, which is obtained by measuring an angle between the long axis of the scaphoid and the mid axis of the lunate. This patient’s SL angle measured 53 degrees (normal 30–60 degrees). Lateral view radiograph of an uninjured wrist. The scapholunate (SL) angle is drawn, which is obtained by measuring an angle between the long axis of the scaphoid and the mid axis of the lunate. This patient’s SL angle measured 53 degrees (normal 30–60 degrees). B The lateral intrascaphoid angle (LISA) is drawn, which is the angle between perpendicular lines on the distal and proximal articular surfaces of the scaphoid. This patient’s LISA measure 23 degrees (normal < 35 degrees)

Fig. 3

Treatment algorithm for acute scaphoid injuries