Fresh scaphoid fractures (analysis of 45 cases).

A study of fresh scaphoid fractures, treated at King Khalid University Hospital between 1983 to 1990, is presented. In a study of 45 patients, there were 43 males (95.5%) and two females (4.5%). Twenty-five patients (55.5%) had fractures on the right side and twenty (44.5%) on the left side. Six patients (13.3%) had fractures in the proximal third, thirty-five (77.7%) in the middle third and four (9%) in the distal third. Among the fractures located in the middle third, twenty-two (62.8%) were displaced and thirteen (37.2%) were undisplaced. Patients included in this study had initial treatment by immobilization in a below elbow thumb spica cast. Ten patients after failure of conservative treatment were treated by compression screw osteosynthesis. In this study, it has been observed that plaster cast immobilisation is a satisfactory method of treatment for stable-undisplaced fractures, while results in patients with unstable-displaced fractures are poor and they are best treated by early open reduction and internal fixation. By assessing the results of this study it is recommended that all scaphoid fractures should be assessed for stability. The treatment by plaster cast should be reserved for fractures involving distal third of scaphoid and for stable fractures of middle and proximal third. The unstable and displaced fractures should be treated by early screw fixation.