Fracture of the carpal scaphoid

Abstract

W e compared the long-term outcome in 61 patients (62 fractures) treated operatively or conservatively for an acute fracture of the carpal scaphoid. A total of 30 fractures was randomised to conservative treatment using a cast and 32 to operative treatment using a Herbert bone screw. The duration of sick leave was shorter for patients treated by operation, but this was only significant in patients with blue-collar occupations. There were no differences between the groups in respect of function, radiological healing of the fracture, or carpal arthritis after follow-up at 12 years. Those managed by operation showed radiological signs of arthritis of the scaphotrapezial joint more often, but this finding did not correlate with subjective symptoms. Operative treatment of an acute fracture of the scaphoid allows early return of function and should be regarded as an alternative to conservative treatment in patients in whom immobilisation in a cast for three months is not acceptable for reasons related to sports, social life or work.

Surgical fixation compared with cast immobilisation for adults with a bicortical fracture of the scaphoid waist: the SWIFFT RCT

“…However, there was no significant difference between the rate of OA in the injured and uninjured wrists assessed, suggesting that much of the identified OA was unrelated to the original fracture. While the literature does suggest that repeat intervention and surgery may exacerbate rates of OA, 27 we found insufficient evidence to support this theory. Therefore, the probability of developing OA is assumed to be treatment independent, as discussed earlier.…”

“…These were reviewed by all reviewers and were resolved. For baseline CT scans, 37 conflicts were identified involving the fracture line (27) and fracture location (10). All of these were reviewed at a conflict meeting in January 2018 and all were resolved.…”

“…Eight randomised controlled trials (RCTs) 3,18,[23][24][25][26][27][28] have reported on 463 participants with undisplaced or minimally displaced fractures of the scaphoid waist who had either of these two treatments. These RCTs had small sample sizes (ranging from 25 to 88 participants) and have been systematically reviewed nine times; [29][30][31][32][33][34][35][36][37] these reviews all commented on the low quality of the evidence.…”

“…Immobilisation of the broken scaphoid in different types of casts has been compared with immediate fixation using a headless screw in at least eight reported trials 18,[23][24][25][26][27][28]75 and one cohort study. 148 These studies (Table 44) .…”

“…One study 36 found that there was no difference between groups after 6 months and others 34,160 found no difference between groups at any time point. Another meta-analysis 30 highlighted the observation that several trials 24,27,28 had noted a better range of wrist movement after treatment in a plaster cast.…”