SUBACUTE SCAPHOID FRACTURES - A CLOSER LOOK AT CLOSED TREATMENT

Twenty-three subacute scaphoid fractures were retrospectively reviewed to determine the efficacy of nonoperative treatment, All of the patie nts sought medical attention between 4 weeks and 6 months after injury , and their fractures were classified according to location and stabil ity, Nineteen fractures were observed to radiographic union or until c losed treatment was abandoned; four patients were lost to followup. Ni ne of 10 stable subacute middle-third scaphoid fractures healed with c ast immobilization in an average of 19 weeks (range, 11 to 38), and th ese were compared with a randomly selected group of acute middle-third fractures that healed in an average of 10 weeks (range, 6 to 13), Fiv e of six unstable subacute middle-third fractures healed in an average of 20 weeks, One of these had a symptomatic humpback deformity treate d by cheilectomy. Of three subacute proximal-third fractures, only one healed after 29 weeks of closed treatment, This study demonstrates th at stable subacute middle-third scaphoid fractures will heal with cast treatment but may take twice as long to do so as stable acute middle- third fractures. Unstable subacute middle-third scaphoid fractures and subacute proximal-third fractures appear less likely to heal with clo sed treatment.