Objective?To determine the effectiveness and safety of surgical treatment compared to conservative treatment for adult acute nondisplaced scaphoid fractures. Methods?We searched the specialized trials registered in the Cochrane muscle group, The Cochrane Library (CCTR), MEDLINE (1966 to 2007), EMbase (1980 to 2007), PubMed (1966 to 2007), NRR, CCT, and CBMdisc (1979 to July 2007). We also handsearched some Chinese orthopedics journals. Randomized controlled trials (RCTs) of surgical treatment versus conservative treatment for adult acute nondisplaced scaphoid fractures were included. The extraction of data and the methodological assessment of included RCTs were performed by two reviewers independently. RevMan software was used to carry out meta-analysis. Results?Five RCTs including 269 patients met the inclusion criteria. Compared with conservative treatment, the time taken before returning to work or participation in sports was shorter in the surgical treatment group. Because of inadequate extraction data and heterogeneity in the included studies, the results of the time of union and grip strength were not consistent. But all the results showed favorable tendencies. No significant difference was found in wrist motion and complications between the surgical and conservative treatment groups. Conclusion?Compared with conservative treatment for adult acute nondisplaced scaphoid fractures, surgical treatment could decrease the time of returning to work or participation in sports, decrease the time of union, and improve grip strength. But it does not improve the wrist motion or decrease the complications. Because of the small sample size, this conclusion should further tested using well-designed, large scale RCTs.
ObjectiveTo discuss the effectiveness of Poking reduction with shoulder arthroscopy-assisted surgery for displaced scapular neck fracture. MethodsBetween January 2009 and January 2012,9 cases of displaced scapular neck fracture underwent shoulder arthroscopy-assisted surgery for Poking reduction treatment.Of 9 cases,6 were men,and 3 were women,aged 21-54 years (mean,39 years).The causes were traffic accident injury in 7 cases,falling injury from height in 1 case,and hurt injury in 1 case.The shoulder abduction,flexion,and external rotation were obviously limited.X-ray films showed all cases had obvious displaced scapular neck fracture.Three-dimensional reconstruction of CT showed a grossly displaced of fracture.The time of injury to surgery was 4-27 days (mean,11 days). ResultsPatients obtained healing of incision by first intension,without infection,neurovascular injury,or other surgery-related complications.All patients were followed up 19-31 months (mean,23 months).X-ray films showed scapular neck fractures healed from 7 to 11 weeks (mean,8 weeks).At last follow-up,the shoulder abduction,flexion,and external rotation activity were improved significantly when compared with ones at preoperation (P<0.05);the shoulder Constant score,American Shoulder and Elbow Surgenos (ASES) score,and Rowe score were significantly better than preoperative scores (P<0.05). ConclusionThe reduction of displaced scapular neck fracture is necessary,and arthroscopic Poking reduction and fixation for displaced scapular neck fracture can reconstruct the shoulder stability and reduce complications