Current concepts of acute scaphoid fractures

Scaphoid fractures represent a common injury, but diagnosis sometimes can be challenging, and a delayed treatment is burdened by severe complication such as avascular necrosis, delayed union or nonunion, with consequent degenerative conditions of the wrist. An early diagnosis and an appropriate treating algorithm are necessary for a good outcome. Clinical suspicion and specific clinical tests help in the diagnosis, but up to 25% of scaphoid fractures remain not detected on initial radiographs. MRI has a high sensitivity for early fractures and CT scan is more indicated to assess the healing process. Conservative treatment with 6 weeks long arm cast is indicated for undisplaced distal third or waist fracture in children or low demanding patients, while proximal pole of the scaphoid usually requires a surgical treatment. Several techniques and implants are proposed, especially percutaneous or minimally invasive fixation, but the surgical approach needs to be considered according to the fracture pattern in order to minimize secondary displacement and increase compression of the fragments. If a proper planning and indications are respected, vascularity is preserved and shear forces on the fragment are reduced, high union rates are achieved.