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

Buijze, Geert A.; Doornberg, Job N.; Ham, John; Ring, David; Bhandari, Mohit; Poolman, Rudolf W.

doi:10.2106/jbjs.i.01214

Cited by 115 publications

(80 citation statements)

References 46 publications

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“…This shows that functional outcome is the same with conservative treatment (DASH) even if patients have a mal-union. A systematic review by Buijze et al [9] showed that surgical treatment of non-and minimally displaced scaphoid fractures, resulted in significantly better patient reports of functional outcome, satisfaction, grip strength and shorter time of work. Arguments for surgery are the intra-operative anatomical reduction and the drawbacks of a prolonged cast immobilisation.…”

Section: Discussionmentioning

confidence: 99%

Functional outcome in conservatively treated non-displaced scaphoid fractures

Drijkoningen¹,

Beeres²,

Leerdam³

et al. 2012

OJCD

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Purpose: This study evaluated the functional outcome after conservative treatment of non-displaced scaphoid fractures using an international validated outcome scale (DASH). Methods and materials: Between 2005 and 2010, 60 patients with a non-displaced scaphoid fracture were included. When a patient visited the emergency department and was clinically suspected of a scaphoid fracture radiography was performed. If no fracture was diagnosed with this modality a CT or MRI-scan both in combination with bonescintigraphy was performed. Patients with scaphoid fractures diagnosed with CT/MRI and bonescintigraphy were treated with a six-week scaphoid forearm cast. Within 1 year after cast removal patients filled in the DASH questionnaire. Results: Sixty (80%) patients returned the DASH questionnaire at 12 months after treatment. Thirty-eight (63.3%) were male and the mean age was 35 (range 11 -83). Forty-four (73.3%) patients had a mid-waist fracture of the scaphoid, 13 (21.7%) had a fracture of the distal pole and three (0.05%) had a proximal fracture. Median DASH score at one year after the trauma was 6 (range 3 -15) for patients with a distal pole fracture and 5 (range 0 -21.5) for mid-waist fractures (p = 0.7, Table 2). For the three patients with a proximal scaphoid fracture the DASH scores appeared higher and were 83, 82 and 30 respectively. Conclusion: Conservative treatment for six weeks with a below the elbow cast is sufficient for the majority of patients with an occult distal or mid-waist scaphoid fracture and results in a good functional outcome according to the DASH questionnaire.

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Section: Discussionmentioning

confidence: 99%

Functional outcome in conservatively treated non-displaced scaphoid fractures

Drijkoningen¹,

Beeres²,

Leerdam³

et al. 2012

OJCD

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“…Displaced proximal pole fractures require a dorsal approach because accurate placement of the screw will then be easier to perform. Surgical treatment is favourable with regard to functional outcome and time off work but is also related to more complications [ 6 ] No signifi cant difference in pain, tenderness, cost, functional outcome or patient satisfaction. In the group treated surgically, the rate of non-union was three times less, there was a quicker return to function and grip strength and range of movement was also transiently better.…”

Section: Surgical Treatmentmentioning

confidence: 99%

Scaphoid Fractures

Lasanianos¹,

Doudoulakis²

2014

Trauma and Orthopaedic Classifications

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DescriptionEighty percent of the scaphoid bone consists of cartilage, leaving limited space for entrance of the supplying arteries. The main blood supply is through retrograde branches of the radial artery. The proximal pole depends on blood supply from the distal pole through the scaphoid bone. In case of a proximal scaphoid fracture, the blood supply through the scaphoid bone is interrupted, making the healing process of the proximal pole particularly more diffi cult. MAYO Classifi cation [ 1 , 2 ]The MAYO classifi cation divides scaphoid fractures into proximal (10 %), middle (70 %) and distal (20 %) fractures (Fig. 24.1 ). Within the distal third, distinction is made between the distal articular surface and the distal tubercle .

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“…In these instances, shared decision making must go beyond providing information to patients (evidence-based data on what could happen) to also receiving it from them (their preferences regarding the perhaps mutually exclusive outcome states). There are numerous orthopaedic clinical cases with an inherent tradeoff between desirable outcome states, including immediate versus delayed reconstruction for acute ruptures of the anterior cruciate ligament [11], arthroplasty versus internal fixation for treatment of displaced femoral neck fractures [4], arthroscopic versus open surgical repairs for management of anterior glenohumeral instability [17], and open reduction and internal fixation versus cast immobilization for nondisplaced or minimally displaced scaphoid fractures [6] (Table 1). In all these cases, the decision selected must be based on the relative values assigned to the possible outcomes; evidence-based medicine cannot, in the abstract, inform us of a universally correct (dominant) decision.…”

Section: Utility Rxà Dxàmentioning

confidence: 99%

“…This study suggests people differ in their value assessments for different outcome states [27], perhaps more so Buijze et al [6] than currently assumed [15]. Therefore, to plan treatments appropriately, orthopaedic surgeons must assess the values patients assign to the various treatment outcome states.…”

Section: Utility Rxà Dxàmentioning

confidence: 99%

The Variability of Patient Preferences

Bernstein

2012

Clinical Orthopaedics &Amp; Related Research

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BackgroundWide variation in procedure utilization suggests that surgical indications might not be rigorously defined. An alternative explanation is that surgical outcomes are valued differently across groups. When a patient, using the information provided by the surgeon, places high value on successful results or is indifferent to the costs of ineffective treatment, the treatment threshold is lower and more surgery will be chosen.

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

Cited by 115 publications

References 46 publications

Functional outcome in conservatively treated non-displaced scaphoid fractures

Functional outcome in conservatively treated non-displaced scaphoid fractures

Scaphoid Fractures

The Variability of Patient Preferences

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