Marijn Rutgers, Robert Shin, Jesse B. Jupiter, David C.
Ring, Chaitanya S. Mudgal
Objectives: Combined fractures of the distal radius and
scaphoid bone are rare. The aim of this study was 1. to present a case series
on patients with combined scaphoid and distal radius fractures, and 2. to
outline features of this injury which may dictate the management technique.
Setting
and Design: A retrospective review was performed on 10 patients with combined fractures of the distal radius
and scaphoid. Radial
fractures were classified using the Comprehensive AO classification. Scaphoid
fractures were classified according to location and displacement of the
fracture. Outcome
was measured in terms of ROM, pain and radiographic signs of healing.
Results: Mean follow-up was 28 months. There was 1
extra-articular radial fracture (type A) and 9 intra-articular fractures (1
type B ; 8 type C). The extra-articular fracture was treated non-operatively in
a cast with a good outcome in terms of ROM and radiographic healing. ORIF was
performed in all of the intra-articular fractures of the distal radius.
Complications included avascular necrosis of the scaphoid (1 patient) and
limitation of ROM (2 patients). At follow-up, all the fractures were
radiographically healed.
Conclusion: In treating combined fractures of the distal
radius and scaphoid, emphasis
should be placed on treatment of the radial fracture. Restoration of articular
congruity and radial length is the priority and ORIF is indicated in all
displaced fractures. External fixation of the radial fracture is not
recommended unless the scaphoid fracture is fixed internally. Undisplaced
fractures in both locations can be treated nonoperatively with good outcomes.
Published by the New England Hand Society 2005.