Partial Union of Acute Scaphoid Fractures

Author(s): Singh HP, Forward D, Davis TRC, Dawson JS, Oni JA, Downing ND.

Source: J Hand Surg 30B:440-445, 2005.


The authors reviewed 66 patients with acute scaphoid waist and proximal pole fractures who were treated in a below elbow cast, that did not immobilize the thumb, for 8-12 weeks.  At 12 to 18 weeks, wrist computed tomography scans in the longitudinal axis of the scaphoid were obtained.  The images showed 30 scaphoid unions, 22 partial unions, and 14 delayed unions.  In 9 of 12 patients with partial unions involving less than 75% of the fracture, repeat CT scans 23-40 weeks post injury showed complete bone healing in 7 cases and progressive bone healing in 2 cases.

The findings from this study support the common occurrence of partial scaphoid fracture healing 3 months post injury (waist and proximal pole fractures).  The results also support continued observation in cases with adequate fracture alignment given the potential for progressive bone healing.  As suggested by these authors and others, CT scans obtained in the longitudinal axis of the scaphoid (thin 1 mm coronal and sagittal slices) or similar reformatting is more reliable than plain radiographs in assessing both scaphoid fracture alignment and union.



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