Clinically SUspected ScaPhoid fracturE: treatment with supportive bandage or CasT? ‘Study protocol of a multicenter randomized controlled trial’ (SUSPECT study)

Abstract

IntroductionSome scaphoid fractures become visible on radiographs weeks after a trauma which makes normal radiographs directly after trauma unreliable. Untreated scaphoid fractures can lead to scaphoid non-union progressing to osteoarthritis. Therefore, the general treatment for patients with a clinically suspected scaphoid fracture and normal initial radiographs is immobilisation with below-elbow cast for 2 weeks. However, most of these patients are treated unnecessarily because eventually less than 10% of them are diagnosed with an occult scaphoid fracture. To reduce overtreatment and costs as a result of unnecessary cast treatment in patients with a clinically suspected scaphoid fracture and normal initial radiographs, we designed a study to compare below-elbow cast treatment with supportive bandage treatment. We hypothesise that the functional outcome after 3 months is not inferior in patients treated with supportive bandage compared to patients treated with below-elbow cast, but with lower costs in the supportive bandage group.Methods and analysisThe SUSPECT study is an open-labelled multicentre randomised controlled trial with non-inferiority design. A total of 180 adult patients with a clinically suspected scaphoid fracture and normal initial radiographs are randomised between two groups: 3 days of supportive bandage or 2 weeks of below-elbow cast. We aim to evaluate the functional outcome and cost-effectiveness of both treatments. The primary outcome is the functional outcome after 3 months, assessed with the Quick Disability of the Arm, Shoulder and Hand score. Secondary outcomes include functional outcome, recovery of function, pain, patient satisfaction, quality of life and cost-effectiveness measured by medical consumption, absence from work or decreased productivity.Ethics and disseminationThe Medical Ethics Committee of the Erasmus MC Medical Centre, Rotterdam, approved the study protocol (MEC-2017-504). We plan to present the results after completion of the study at (inter)national conferences and publish in general peer-reviewed journals.Trial registration numberNL6976.

Evaluating the potential for cone beam CT to improve the suspected scaphoid fracture pathway: InSPECTED: A single-centre feasibility study

“…Over-treatment of suspected scaphoid injuries is an ongoing challenge [1] . Cohen et al [26] stated that less than 10% of patients placed on follow up pathways are ever diagnosed with a fracture. In our study, 20% of those referred for CBCT were confirmed positive for bony injury, although the number of scaphoid fractures were small.…”

The Medium-Term Outcomes of Patients With Suspected Scaphoid Fractures: A Single-Centre Retrospective Cohort Study

“…Usual management of patients with suspected scaphoid fractures involves immobilisation in a cast or splint and further imaging to either exclude or confirm a definite fracture [6].…”