Precutaneous screw fixation vs cast immobilization?

DJ Urbanovsky · 08-17-2016, 18:54

Ok, my medical professionals. Feedback needed, please.

Loved one broke her wrist on 4 July, has been in a cast since. Non-displaced scaphoid fracture. She was due to get her cast off today, but doc is not satisfied with fracture union and wants to do precutaneous screw fixation rather than further cast immobilization. Subject is early 30's and in good health. She is not sure that she is on board with the surgery.

Search query on the forum on key words turned up nothing, so I/we are interested in your experiences regarding similar injuries, and if they parallel linked study. And would you lean more towards further cast immobilization or screw fixation?

The study http://jbjs.org/content/83/4/483

Thanks in advance.

**Ambush Master** · 08-17-2016, 19:51

D,

You may want to start collecting as many/all of the X-Rays as possible in Digital Format so that they can be sent with an E-mail!! Trust me,this will expedite the process even if it's local. When our oldest though that he had broken a finger, the Wife took him to her Office (She's a Dental Hygienist) and X-Rayed him with their Machine!! The Pedi-Doc said that it was the FIRST time that a Patient had come in with their own Pics!!

When I broke 11 Ribs on opening (Parachute Type) 5 years ago, having the Digital Pics helped with subsequent visits to other Docs!!

Do take care!!
Martin

DJ Urbanovsky · 08-17-2016, 20:08

Roger that. Thank you, sir! I will see if she can provide me with radiography.

miclo18d · 08-18-2016, 05:37

18D advice should be taken with a grain of salt here as we are not doctors.

After reading some sites non-displaced fractures generally heal well without surgical intervention but require strict immobilization.

Quote:

Nondisplaced distal fractures heal well with strict immobilization in a well-molded short arm thumb spica. Controversy exists over whether to use a long arm or a short arm cast. One comparison16 found that nondisplaced fractures healed well regardless of the type of cast that was used. Current treatment for this type of fracture is a thumb spica, but some evidence suggests that the thumb could be omitted from the cast. A randomized prospective trial17 found that immobilization of the thumb did not improve outcomes for nondisplaced fractures. Screw fixation may speed recovery to pre-injury activities; referral for surgery may be indicated, depending on the needs of the patient.18 As the fracture line moves proximally, there is more risk of displacement and nonunion; therefore, it would be appropriate to refer these patients for orthopedic consultation.If conservative treatment is attempted, a long arm cast with thumb immobilization is appropriate.

Fractures with even small amounts of displacement are prone to nonunion, and operative treatment is recommended.19 Splinting and referral are indicated.

Bottom line refer to a good Ortho Doc and see what they say, or seek a 2nd opinion. Many start with conservative treatment as opposed to pulling out the shotgun (surgery) and blasting away.

Red Flag 1 · 08-18-2016, 08:58

It really is a decision she and her doctor have to agree to.

DJ Urbanovsky · 08-18-2016, 13:35

Thanks for the assist, guys.

DJ Urbanovsky · 08-18-2016, 13:45

Of course. This is just another tool to populate the data pool.

Quote:

Originally Posted by Red Flag 1

It really is a decision she and her doctor have to agree to. We have no way of seeing the patient, doing a physical exam, or looking at the fracture. There is no way you can replace the "clinical eye" of her doc, with an internet opinion.

DJ Urbanovsky · 08-18-2016, 13:41

You may not be doctors, but you're a wealth of real world knowledge and experience. That said, I did read the sticky up at the top of the forum about how no warranties are expressed or implied prior to posting.

She's got a good ortho/hand specialist, and has opted to go with the non-shotgun option first. Already floated idea of getting a second opinion to put her mind at ease. She does have a cast with full thumb imobilization.

Quote:

Originally Posted by miclo18d

18D advice should be taken with a grain of salt here as we are not doctors.

After reading some sites non-displaced fractures generally heal well without surgical intervention but require strict immobilization.

Bottom line refer to a good Ortho Doc and see what they say, or seek a 2nd opinion. Many start with conservative treatment as opposed to pulling out the shotgun (surgery) and blasting away.