Fractures of the tarsal scaphoid

PURPOSE OF THE STUDY: The authors relate a series of 47 cases of tarsal scaphoid fractures, between 1976 and 1992. MATERIAL AND METHODS: These fractures occurred 11 times after a high level fall, 28 times after a motor vehicle accident and 8 times after a direct traumatism. The fracture line was vertical 35 times; horizontal 27 times. An impaction was often associated (32 cases). In 17 observations, a true enucleation occurred as a part of the fracture dislocation. Many periscaphoidal lesional associations were found. 39 fractures were fixed. Radiographs showed 30 consolidations with an anatomical reduction. 37 patients were reviewed with an average follow up of 7 years and 6 months. RESULTS: Results were assessed using Mestagh's scoring system: 7 very good, 15 good, 6 fair and 9 bad. The very good and good results represent 59 per cent. In 37 patients reviewed, the clinical investigation showed 8 deformities of valgus flat foot, a varus foot, requiring 11 times orthopedic soles wearing. 11 patients had a lameness. Radiological results showed 11 times a peri-scaphoidal arthrosis, a necrosis and 2 non union. A narrowing of the astragalo-cuneate joint line was found 8 times. DISCUSSION: Various anatomical types don't have the same prognosis. Vertical and horizontal fractures gave 18 times a very good and good result when in 11 reviewed patients with a fracture dislocation, we noticed 7 poor or bad result. An osteosynthesis by screw gives goods results when fragments are large. For compound fracture when a surgical procedure will be insufficient, the conservative treatment, if keeps a sufficient breadth of medial arch, can give a satisfactory result. An immediate astragalo-scaphoidal arthrodesis can be suggested in front of a multi-fragmentary dislocation fracture. CONCLUSION: The scaphoidal tarsal fracture is unusual and its diagnosis remains sometimes difficult. The treatment is often surgical by direct approach. In consideration of the pejorative post-operative outcome of fracture dislocations, some authors suggest an immediate astragalo-scapho-cuneate arthrodesis.