Comparision between functional outcome of scaphoid fracture treated by open reduction internal fixation vs percutaneous fixation

Abstract

Scaphoid bone fracture is one of the commonest carpal bone fractures. It is predominantly seen in young population. Unstable or displaced scaphoid fractures can be treated either by primary use of cast immobilization alone, by use of Open Reduction Internal Fixation (ORIF) technique or by percutaneous fixation with Herbert screw under direct C arm fluoroscopic guidance. This study aims to review clinical, radiological and function outcome following ORIF technique Vs Percutaneous Fixation Technique in scaphoid fractures.Cases of acute scaphoid fractures who came to our department and met inclusion and exclusion criterias were identified and included in this study. Clinical details of these patients were obtained and scaphoid radiographs were taken. Injuries were graded as per Herbert and Fisher Classification. All our cases underwent grip-strengthening exercises and relevant physiotherapy Clinico-radiological details of our cases were obtained at each follow-up. Final follow-up of our cases was performed using Modified Mayo Wrist Score (MMWS). Grip strength was graded as per Medical Research Council (MRC) scale and range of motion was assessed using goniometer.A total of 40 cases were enrolled in our study. 16 patients (40% cases) underwent percutaneous herbert screw fixation and rest of our cases underwent open reduction and internal fixation. Radiological union in cases treated with percutaneous fixation was faster as compared to cases treated by ORIF. Also patients treated with percutaneous method demonstrated higher mean range of motion score, mean grip strength score and activity score.In our study excellent results have been obtained in cases treated with percutaneous approach in terms of post-operative morbidity and this approach also allows earlier return to sports and work thereby necessitating importance of this approach over ORIF approach in a developing resource poor country like India.