Recent scaphoid fractures (within the first three weeks)

Scaphoid fractures are the most common carpal fracture, accounting for 70 a 80% of all fractures of the wrist. The diagnosis of acute fracture of the scaphoid still continues to be missed despite an increasing improvement of imaging techniques. In fact, these fractures are mainly neglected because of minimal early symptoms or quick resolution of initial symptoms. X-ray analysis of acute fractures is rather difficult because of the irregular shape of the scaphoid and its overlapping with other structures. In case of doubtfull or negative initial radiographic views, a technetium 99 bone scan or MR imaging should be consisidered. These fractures occuring in the young and most active members of our society represents a population that doesn't have the patience for traditionnal immobilisation in cast. Thus patients with undisplaced fractures for whom early return to work or sport is a primary concern, percutaneous repair with cannulated screw fixation using fluoroscopy and even aided with arthroscopy represents an increasing option. Nevertheless, in thoses cases, cast immobilisation should always be first considered. If percutaneous internal fixation is the first choice in proximal pole fractures or fractures seen with a delay, in the other cases, it can only be advocated if internal fixation will provide a stable reduction. There is little controversy for the treatment of displaced unstable scaphoid fractures. Open repair and internal fixation with a screw represents the golden standard. Complex displaced or dislocated fractures are often comminuted and associated with bony defect. Accurate reduction may need to perform a bone graft. The ligamentous injuries should also be carefully repaired . Evidence of associated cartilagenous lesions must be asessed with precision, as they always jeopardize the end result.