PERCUTANEOUS FIXATION VERSUS NON-OPERATIVE TREATMENT IN ACUTE NON-DISPLACED AND MINIMALLY DISPLACED SCAPHOID FRACTURES: A COMPARATIVE ANALYSIS

Abstract

Background: Scaphoid fracture is one of most common fractures of carpal bones. These injuries most commonly occur due to a fall on an outstretched hand resulting primary impacts on the scaphoid waist which is the most vulnerable segment of the bone. Non-displaced and minimally displaced scaphoid fractures have been treated conservatively with below-elbow thumb spica cast immobilization, which comes with complications. To overcome these limitations, minimally invasive surgical techniques such as percutaneous screw fixation is implicated. This study is conducted to compare the clinical and radiological outcomes of percutaneous screw fixation versus conservative cast immobilization in patients with acute non-displaced or minimally displaced scaphoid waist fractures.

Methods: This prospective comparative study was conducted at Saveetha Medical College over a period of two years (January 2023 to January 2025), including 50 patients with acute scaphoid fractures. Patients were divided into two groups: Group A (n=25) underwent percutaneous fixation, and Group B (n=25) received cast immobilization. Outcomes assessed included time to radiological union, functional scores (Modified Mayo Wrist Score, DASH), return to work, and complication rates.

Results: The mean time to union was significantly shorter in Group A (7.4 ± 1.2 weeks) compared to Group B (11.2 ± 2.5 weeks, p<0.001). Group A also showed better functional outcomes with higher Modified Mayo Scores (91.6 vs. 84.2, p=0.002) and lower DASH scores (8.2 vs. 14.6, p<0.01). Complication rates were lower in the surgical group, with no cases of non-union, while the conservative group had three cases of non-union and four delayed unions. The mean time to return to work was earlier in Group A (5.6 weeks vs. 9.3 weeks, p<0.001).

Conclusion: Percutaneous screw fixation offers superior radiological and functional outcomes with faster recovery and fewer complications compared to conservative management in acute non-displaced or minimally displaced scaphoid fractures. It should be considered as a preferred option, especially for active individuals requiring early return to activity.