Treatment of the Delayed/Nonunion of Scaphoid Fracture by Short-arm Cast Immobilization Leaving All the Metacarpophalangeal Joint Free / 中国运动医学杂志

ABSTRACT

Objective To study the clinical results of the short-arm cast immobilization leaving all the metacarpophalangeal joints free in the management of the delayed/nonunion of scaphoid fracture. Methods From August 1999 to January 2008, 18 cases of delayed/nonunion of scaphoid fracture were studied, including 2 cases with avascular necrosis in the proximal fragment and 2 cases with partial sclerosis. The average time from the injury was 6.3 months (range 2～12 months). The wrist was immobilized with a short-arm cast (from 5 cm below the elbow to the middle palmar crease), leaving all the metacarpophalangeal joints free until the fracture showed radiological signs of union. The wrist was fixed in 10 degrees of dorsiflexion and 20 degrees of ulnar deviation. All cases were reviewed every one or two months, and the cast should be changed if loose. Union of fracture was determined by plain radiograph. Results Union rate confirmed by plain radiograph was 88.9%(16 of 18) and average duration of cast was 4.7 months (range 3～8 months). Two cases with avascular necrosis in the proximal fragment achieved union after 5 and 6 months immobilization respectively. Of two failure cases of nonunion, one with partial sclerosis was immobilized for 5 months without signs of union and the other abandoned treatment after 2 months immobilization. Fourteen of the sixteen healed cases were followed up(with average of 9.3 months )after cast removal. Four cases were reported of 10 degrees dorsiflexion limitation of the wrist and three cases complained of mild pain during movement. Conclusion The delayed/nonunion of scaphoid fracture within 1 year after injury and without obvious sclerosis could achieve union with the short-arm cast immobilization leaving all the metacarpophalangeal joints free. The delayed/nonunion of scaphoid fracture with avascular necrosis in the proximal fragment need long term immobilization and also had chance of union.