This narrative review synthesizes evaluation and management of acute scaphoid fractures from the year 2000. It addresses how to assess displacement, which fracture patterns require surgery, and the emerging role of percutaneous cannulated screw fixation as an alternative to prolonged casting. The paper is a foundational reference for understanding operative indications and the imaging limitations that drive clinical decision-making.
Standard radiographs systematically underestimate scaphoid fracture displacement because of the bone's complex three-dimensional geometry. Before CT became routine, displaced fractures were likely undertreated, contributing to avoidable nonunion.
When you see a scaphoid fracture, get a CT in the plane of the scaphoid before calling it nondisplaced. If any of Cooney's criteria are met (gap >1 mm, SL angle >60°, RL angle >15°, intrascaphoid angle >35°), the fracture needs operative fixation.
For fractures found late (4 weeks or more after injury), recommend surgery regardless of displacement — the 19%-88% nonunion rate with delayed immobilization makes conservative management difficult to justify.
For athletes or manual laborers with a confirmed nondisplaced fracture, percutaneous cannulated screw fixation is a legitimate alternative to casting, with early data showing 100% union and return to work within 5 weeks.
This narrative review synthesizes evaluation and management of acute scaphoid fractures from the year 2000. It addresses how to assess displacement, which fracture patterns require surgery, and the emerging role of percutaneous cannulated screw fixation as an alternative to prolonged casting. The paper is a foundational reference for understanding operative indications and the imaging limitations that drive clinical decision-making.
Standard radiographs systematically underestimate scaphoid fracture displacement because of the bone's complex three-dimensional geometry. Before CT became routine, displaced fractures were likely undertreated, contributing to avoidable nonunion.
When you see a scaphoid fracture, get a CT in the plane of the scaphoid before calling it nondisplaced. If any of Cooney's criteria are met (gap >1 mm, SL angle >60°, RL angle >15°, intrascaphoid angle >35°), the fracture needs operative fixation.
For fractures found late (4 weeks or more after injury), recommend surgery regardless of displacement — the 19%-88% nonunion rate with delayed immobilization makes conservative management difficult to justify.
For athletes or manual laborers with a confirmed nondisplaced fracture, percutaneous cannulated screw fixation is a legitimate alternative to casting, with early data showing 100% union and return to work within 5 weeks.