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THE BROKEN SCAPHOID BONE

The Case Against Pessimism



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Abstract

1. The bad reputation of fractures of the scaphoid bone is based on a) past disasters caused by inadequate splintage and premature resort to operation; and b) selection of disabling cases for publication.

2. The results obtained in five series comprising over 1,000 fractures suggest that 95 per cent of adequately studied fractures less than a month old unite if properly treated.

3. Sixty cases of established non-union have provided evidence that disability is almost always the result of further injury and that the disability is usually relieved by a short time in plaster.

4. There is no evidence to support the widely held beliefs that a) union by bone can occur only if the fracture is immobilised throughout the process; and b) union after prolonged immobilisation is due to the immobilisation.

5. A policy of treating the wrist and not merely its radiological appearances is advocated.

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