Comparison of direct and indirect costs of internal fixation and cast treatment in acute scaphoid fractures: A randomized trial involving 52 patients

Abstract

There was a longer period of absence from work after cast than after surgery in manuals, but not in non-manuals. In non-manuals, total costs were lower after cast than after surgery. Socioeconomic classification had a greater influence on cost than mode of treatment.

Surgical Compared with Conservative Treatment for Acute Nondisplaced or Minimally Displaced Scaphoid Fractures

“…The rate of loss to follow-up, reported in all studies, ranged from 0% to 26%. The authors of four of the eight studies clearly stated that their analysis was based on intention-to-treat principles 13,18,32,34 . The authors of three studies reported on cross-over to surgical treatment 18,32,33 ; however, Saedén et al 33 did not clearly state whether they performed an intention-to-treat analysis.…”

“…In 2007, Vinnars et al 34 studied the data for a subgroup of fifty-two patients from the same randomized trial reported by Vinnars et al in 2008 18 . They included acute nondisplaced fractures of the scaphoid (Herbert type-A2, B1, B2, and B3 fractures).…”

“…The analysis of time off work from five studies 13,14,31,33,34 revealed a significant difference in favor of surgical treatment (standard mean difference = -1.69, 95% confidence interval = -2.70 to -0.68, p < 0.01, I 2 = 89%) (Fig. 3).…”

“…There was no significant difference in treatment effect (risk ratio = 0.98, 95% confidence interval = 0.91 to 1.05, p = 0.54, I 2 = 0%). The data from two studies on the total costs of treatment 31,34 were pooled, and the analysis showed no significant difference between treatment groups (standard mean difference = -0.10, 95% confidence interval = -0.50 to 0.30, p = 0.2, I 2 = 0%).…”

“…Six studies evaluated time off work 13,14,[31][32][33][34] , three evaluated return to previous activity 13,18,30 , and two evaluated costs 31,34 . All studies evaluated complications 13,14,18,[30][31][32][33][34] .…”