Diagnosis and treatment of scaphoid fractures, can non-union be prevented?

In order to evaluate the diagnostic management of scaphoid fracture, 100 co nsecutive patients with clinically suspected scaphoid fractures were invest igated. If a scaphoid fracture was seen on scaphoid radiographs, patients w ere immobilized in a plaster cast. If the radiographs were negative or dubi ous for scaphoid fracture, patients were referred for three phase bone scin tigraphy. Then the patient was treated according to the result of the bone scan. A long-term follow-up (minimum 1 year) was performed in order to eval uate the incidence of nonunion. In 49 of the 100 patients, a fracture of th e scaphoid was recognized, in 29 of whom their scaphoid X-series was positi ve for scaphoid fracture. In 3 of the remaining 71 patients with negative s caphoid X-series, additional carpal box radiographs showed a scaphoid fract ure, while 68 patients were referred for three-phase bone scintigraphy. Of these 68 patients, 17 patients (25%) showed a hotspot on the bone scan in t he region of the scaphoid. We found that scaphoid radiographs. additional c arpal box radiographs and the bone scan (in radiographically negative patie nts) in combination with conservative therapy did not lead to non-union at long-term follow-up in patients who were treated for scaphoid fracture. We conclude that when a scaphoid fracture is diagnosed within the Ist week fol lowed by plaster immobilization, non-union of the scaphoid could be prevent ed.