The results of treatment of 734 fresh, simple fractures of the scaphoid

In the period from 1.12.1925 to 31.12.1952, 734 fresh, simple fractures of the scaphoid body were treated in 732 patients at the Accident Hospital in Vienna. In order to overcome diagnostic difficulties, technically perfect radiographs were required, and special views of the scaphoid were proposed, as well as X-ray checks after 2 and 4 weeks in the case of questionable fissures. In describing the types of fracture, a new classification was used, based on the course of the fracture gap; here, attention was drawn in particular to the vertical oblique fracture, which presents diagnostic and therapeutic difficulties. Immobilization was achieved either with a simple dorsal plaster-splint or with a dorsal splint that also included the thumb. The overall average period of fixation was 59.14 days, this period being somewhat longer in cases where the thumb was included in the splint. Patients were on sick leave for an average of 68.28 days, and the duration of treatment averaged 75.79 days. In the progress of fracture healing, the occurrence of calcium-dense stripes was emphasized as a particular indication of bone healing, and the behaviour of the calcium density in the proximal bone fragment was discussed. Follow-up examinations 1-28 years (average around 8 years) after the accident were possible in 580 (79%) of the 734 scaphoid fractures. Out of 576 usable cases, the bone had healed in 557 cases (96.65%), and 19 (3.35%) had pseudarthroses. Besides those already known to us, new causes of pseudarthroses were found to be the vertical oblique fracture and the presence of diastasis between the fragments of bone; a period of fixation lasting 10-12 weeks was proposed for these cases. Inclusion of the thumb in the plaster cast appears to delay fracture healing, particularly in the case of diastasis. Arthroses were found in 20 cases (3.54%), but only in 1.1% of healed cases. In clinical terms, change of job due to the accident, severe problems, and restricted movement of the wrist of more than 10° were found in only an insignificant percentage of the cases where the bone had healed. Of the patients with pseudarthroses, around 20% had to change their job as a result of the consequences of the accident, around 40% had serious problems, and 20-40% had restriction of movement greater than 10°. Of the 732 people injured, 533 sustained accidents at work that were covered by insurance and without serious collateral injuries: of these, only 4 (0.75%) receive a long-term 20% pension.