Questions regarding the evidence guiding treatment of displaced scaphoid fractures

European Board of Hand Surgery (EBHS) Examination Questions

“…Dias JJ and Singh HP (2011) suggest up to 85% to 90%. You may wish to read the recent paper by Johnson et al (2021).…”

Acute scaphoid fractures: making decisions for treating a troublesome bone

“…Two displacements commonly measured are gap or step (translation) between fracture fragments (Johnson et al., 2020). We commonly use the 1-mm threshold to indicate a displacement of concern in either the step or the gap (Grewal et al., 2013).…”

Re: Johnson NA, Morris H and Dias JJ. Questions regarding the evidence guiding treatment of displaced scaphoid fractures. J Hand Surg Eur. 2020, 46: 213–8

“…The surgery versus cast immobilisation for adults with a bicortical fracture of the scaphoid waist (SWIFFT) trial also identified over double the risk of delayed union (13%) in displaced fractures versus nondisplaced (6%), although this difference did not reach statistical significance (p = 0.087 Fisher's exact test two-tailed on data in Table 1). Notably, the SWIFFT trial's full report described a detailed analysis of inter-observer reliability in 'Appendix 5: Analysis of the agreement between raters on the imaging' (Dias et al, 2020). All Xrays and CT scans were assessed independently by three raters.…”

“…2020, 46: 213-8 We read this article with interest. The authors make a number of excellent points (Johnson et al, 2020), including that many fracture classifications have not included displacement. The authors state that the 'consequences of a displaced scaphoid fracture and nonunion are not firmly established', although this is somewhat at odds with the reported findings of the cited systematic review (Eastley et al, 2012).…”