2017 Arthroscopy Journal
Scaphoid fractures account for up to 70% of all carpal fractures in athletes, usually affecting young male patients. These injuries are usually associated with a traumatic event; however, stress fractures of the scaphoid have also been reported. Many scaphoid fractures presenting in the acute phase have “normal” initial radiographs, which can sometimes lead to a missed or late diagnosis. For this reason, one should have a high level of suspicion when assessing contact athletes with radial wrist pain, and computed tomography (CT) or magnetic resonance imaging (MRI) can be obtained to further assess for a nondisplaced fracture.
Although conservative treatment with immobilization provides good clinical outcomes in nondisplaced fractures, surgery is often recommended if there is displacement or a step-off greater than 1 mm. The risk of nonunion of displaced fractures can be as high as 17 times greater with immobilization treatment compared with surgical fixation. Complications after nonoperative treatment include symptomatic pseudarthrosis, malunion, and osteonecrosis, whereas surgical complications also include symptomatic hardware, neurovascular injury, and persistent pain. Despite good functional outcomes and healing rates after nonoperative management, it often entails long-term immobilization that is not favorable for athletes and manual workers.
Some authors have recommended surgical management of scaphoid fractures, regardless of the presence of diastasis in these patients, and reported good outcomes and a faster return to activity. The purpose of this study was to report on the clinical and radiologic outcomes and complications after surgical treatment in National Football League (NFL) Combine athletes with a history of a scaphoid fracture. We hypothesized that those with scaphoid fractures treated surgically would have good to excellent objective outcomes.