Combined Fractures of the Scaphoid and Distal Radius: Evaluation of Early Surgical Fixation (21 Patients with 22 Wrists)

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Abstract

Introduction The purpose of this retrospective study, is to evaluate the clinical and functional results of early surgical fixation of the ipsilateral distal radius and scaphoid fractures in 22 of 21 patients.

Patients and Methods Overall, 22 combined ipsilateral scaphoid, and distal radius fracture treatments between 2002 and 2015 were evaluated. The mean age was 34.9 (range: 19-82) years. One patient had bilateral injuries. In 17 patients the injury was due to a fall from a height, and in 4 patients due to a motorcycle accident. According to the AO classification, there were 2 type B and 20 type C fractures of the distal radius. The volar locking plate fixation technique was applied in 14 wrists, screw fixation technique in 1, external fixation combined with Kirschner wires (K-wire) stabilization technique was used in 3 wrists, and only K-wire pinning technique was used in 4 wrists. All scaphoid fractures were type B (21 type B2, 1 type B1) according to the Herbert-Fischer classification. K-wire fixation was applied in 2 and cannulated screw fixation was performed in 20 fractures. Clinical evaluation was performed with measuring the pinch power, grip power, and range of motions. Functional evaluation was performed using patient-rated wrist evaluation score (PRWE).

Results The average follow-up period was 25 (range: 12-97) months. All radius and scaphoid fractures healed. The mean active wrist motions were found to be 45 degrees of flexion, 48.5 degrees of extension, 20 degrees of radial deviation, and 43 degrees ulnar deviation. Mean grip/pinch strengths were 31/8.5 kg. Mean PRWE score was 5.5 (range: 0-8.5). All patients returned to preoperative activity level and can do preinjury jobs.

Conclusion Combined ipsilateral fractures of distal radius and scaphoid are complex and rare injuries due to high energy traumas. Stable early primary fracture fixation in these injuries can be expected with good functional results.

Level of Evidence Level IV.

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