Percutaneous Fixation of Scaphoid Fractures: A Systematic Review

Abstract Background percutaneous fixation of acute non-displaced or minimally displaced scaphoid fractures, especially in young active individuals in whom prolonged immobilization can be a significant burden, provides excellent results regarding functional outcome, earlier gain of motion of the wrist, earlier time to union, quicker return to activity of daily living, and a lower complication rate. Aim of the Work to assess the outcomes of acute, un-displaced scaphoid fractures managed with percutaneous or mini-open screw fixation in terms of time to return to work (RTW), time to union, morbidity, and functional evaluation of the outcome. Materials and Methods This is a systematic review done in percutaneous fixation of scaphoid fractures. Results One hundred and nine patients were included in this study who undergone percutaneous fixation of scaphoid fracture. The range of age was between 16-55 years old. There was male predominance with 79% compared to females. 60% of included patients was RT handed dominant. Regarding complications 15.6% of cases (total of 17 patients) were complicated. Complications were like screw protrusion, sympathetic dystrophy, non-union, wire breakage during fixation, breakage of screw driver, and superficial wound infection. The position of screws was central in most cases except four patients which had eccentric screw position but with good outcome in 3 of them. Regarding time to union, the average time to union was 5-18 weeks as proven by PXR and CT. Regarding return to work, the average recorded time to return to work was 2-12 weeks. Regarding range of motion 84.4% regained full range of motion as compared to the healthy side. Regarding pain assessment only 50% of patients were included in pain assessment, 51 patients had little or no pain at final follow-up. Regarding grip strength, 91 patients had the same grip strength compared to healthy side at final follow-up. The functional end result acc. to Mayo modified wrist score, 57 patients had excellent outcome. Four patients had good outcome. One patient had fair outcome. One patient had poor outcome. There were a number of different immobilization techniques and regimes used in the included studies. A clear benefit of surgical stabilization is that it reduces the requirement for post-operative immobilization, facilitating an accelerated return to work and sporting activities. Conclusion Percutaneous fixation of acute non-displaced or minimally displaced scaphoid fractures, especially in young active individuals in whom prolonged immobilization can be a significant burden, provides excellent results regarding functional outcome, earlier gain of motion of the wrist, earlier time to union, quicker return to activity of daily living, and a lower complication rate.