Surgical versus nonsurgical treatment for scaphoid waist fracture with slight or no displacement

Li, Hangyu; Guo, Wenlai; Guo, Shanshan; Zhao, Shuhong; Li, Rui

doi:10.1097/md.0000000000013266

Cited by 13 publications

(16 citation statements)

References 63 publications

(91 reference statements)

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“…2 Immediate surgical fixation is said to avoid the need for a cast and accelerate return to function, work, and sport 7 but exposes patients to surgical risks. Eight small randomised clinical trials in United Kingdom, United States of America (USA) and Sweden, 8 of variable quality, reporting on undisplaced or minimally displaced fractures of the scaphoid waist, provide unclear evidence on whether surgical fixation gives better outcomes than cast immobilization. Despite insufficient evidence there is an increasing trend 9 to immediately fix this fracture for perceived short-term benefits, but concerns remain about the lack of evidence on long-term benefits and additional risks from surgery, such as malunion, infection, and implant related problems.…”

Section: Introductionmentioning

confidence: 99%

Surgery versus cast immobilisation for adults with a bicortical fracture of the scaphoid waist (SWIFFT): a pragmatic, multicentre, open-label, randomised superiority trial

et al. 2020

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BackgroundScaphoid fractures account for 90% of carpal fractures and occur predominantly in young men. Immediate surgical fixation of this fracture has increased, in spite of insufficient evidence of improved outcomes over non-surgical management. We compared the clinical effectiveness of surgical fixation with cast immobilization and early fixation of those that fail to unite, for ≤2 mm displaced scaphoid waist fractures in adults. MethodsThis pragmatic, multicentre, open-label, parallel-group, two-arm randomised clinical trial included adults who presented to orthopaedic departments of 31 hospitals in England and Wales with a clear, bicortical fracture of the scaphoid waist on radiographs. Participants were randomly assigned to early surgical fixation or below-elbow cast immobilization followed by immediate fixation of confirmed non-union. The primary outcome was the Patient Rated Wrist Evaluation (PRWE) total score at 52 weeks post-randomisation. Registration ISRCTN67901257. FindingsOf 439 randomised patients (mean age 33 years, 363 [83%] men), 408 (93%) were included in the primary analyses. There was no difference in PRWE score at 52 weeks (adjusted mean difference -2•1 points, 95% CI -5•8 to 1•6, p=0•27). There were no differences at 52 weeks for the PRWE pain or function subscales. More participants in the surgery group experienced a surgery-related potentially serious complication than in the cast group (n=31, 14% vs n=3, 1%), but fewer had cast-related complications (n=5, 2% vs n=40, 18%). The number experiencing a medical complication (n=4, 2% vs n=5, 2%) was similar in the two groups." InterpretationAdult patients with ≤2 mm displaced scaphoid waist fracture should have initial cast immobilization and suspected non-unions confirmed and immediately fixed. This will help avoid risks of surgery and mostly limit its use to fixing non-union.

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Section: Introductionmentioning

confidence: 99%

Surgery versus cast immobilisation for adults with a bicortical fracture of the scaphoid waist (SWIFFT): a pragmatic, multicentre, open-label, randomised superiority trial

et al. 2020

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“…7 Ibrahim et al and Li et al found similar results in their meta-analyses, suggesting better outcomes with open fixation versus nonsurgical management, while there was no significant difference in union rates with percutaneous versus nonsurgical management. 4,5 Overall, these studies suggest that the assumption that open techniques are superior to percutaneous approaches is not empirical and requires more investigation.…”

Section: Discussionmentioning

confidence: 98%

“…Low complication rates and high rates of union with open and percutaneous fixation of the scaphoid have been documented in numerous studies. 2,4,5,7 When compared with percutaneous techniques, open fixation provides the benefit of better visualization of the starting point of the central axis guidewire. 15 This visual advantage does allow some surgeons to be more accurate with guidewire and screw placement.…”

Section: Discussionmentioning

confidence: 99%

“…A better understanding of actual complication rates is especially important when counseling our patients and when considering these described meta-analyses that have raised doubt about the superiority of one approach over the other. 4,5,7 Our mini-open and percutaneous techniques are similar to perform, with both techniques having the same goals for reduction, guidewire placement, and screw placement. The main difference involves the ease offered by the mini-open approach in visualizing the guidewire starting point, allowing for more optimal screw placement down the central axis of the scaphoid.…”

Section: Discussionmentioning

confidence: 99%

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A Retrospective Review of Differences in Complication Rates between Dorsal Percutaneous and Mini-Open Surgical Fixation of Scaphoid Fractures

et al. 2020

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Objective We retrospectively reviewed the complications of 80 cases of scaphoid screw fixation in acute fractures and early nonunions comparing dorsal percutaneous and mini-open approaches. Methods We performed a chart review of all patients who underwent surgical fixation of a scaphoid fracture or a nascent nonunion using a dorsal percutaneous or dorsal mini-open technique by a single surgeon. We collected data on patient demographics, including age and smoking status, time to surgery, fracture type, union, and the major and minor complications that occurred in each group. Fisher's exact tests were used to compare the complication rates between the groups. Results We identified 80 patients who underwent surgical fixation. Of these, 44 underwent percutaneous fixation and 36 underwent mini-open fixation. All fractures went on to heal. There was a total of five complications identified. There were no major complications in the percutaneous group, but one major complication in the mini-open group (a delayed union that eventually healed at 6 months). There were two minor complications in each group. There was no statistically significant difference in total, major, or minor complication rates between the groups. Conclusions This study suggests that a dorsal percutaneous surgical technique for scaphoid fracture repair does not affect the complication rate despite prior literature to the contrary. Both techniques analyzed produce excellent rates of union with very low complication rates. Surgeon-specific technique rather than operative approach or exposure may be responsible for previously reported complication rates in the fixation of scaphoid fractures. Level of Evidence This is a level III, therapeutic study.

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“…19 Closed reduction and percutaneous fixation with different types of cannulated screws under fluoroscope is nowadays gaining popularity because it shortens the time to union and convalescence. 20 Anyhow, chronic waist fractures may need open reduction and bone grafting along with stable fixation for early range of motion. Even small sized distal pole fractures which are neglected and symptomatic can be excised.…”

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confidence: 99%

Demographic and Clinical Profile of Adult Patients With Scaphoid Fractures in Population of District D.I.KHAN, Pakistan

Khan

Rasheed

Hussain

et al. 2020

GJMS

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Background: Scaphoid fractures are common and account for 60-70 % of all carpal fractures. The objectives of this study were to determine the demographic and clinical profiles of adult patients with scaphoid fractures in population of District D.I.Khan, Pakistan. Materials & Methods: This cross-sectional study was conducted in Department of Orthopedics, Gomal Medical College, D.I.Khan, Pakistan from January 2015 to December 2019. Sample size was 40. Demographic variables were sex, age groups and time to presentation in weeks. Research variables were; cause, laterality, site, management options, time to union in months and presence of infection. All variables were categorical and analyzed by count and percentages for sample and as CI at 80% CL for proportion for population using Wilson score for binomial distribution. Results: Forty patients included 34 (85%) men & 16 (15%) women, 24 (60%) in 17-30 and 16 (40%) in age group 31-50 years. Time to presentation was ≤1 week of injury in 19 (47.5%) patients and 21 (52.5%) presented later. Cause was fall on out-stretched hand in 27 (67.5%) and RTA in 13 (32.5%) patients. Right hand was involved in 29 (72.5%), left in 9 (22.5%) while bilateral in 2 (5%) patients. Site of fracture was waist in 24 (60%), proximal pole 11 (27.5%) and distal pole 5 (12.5%) cases. Conservative treatment was done in 7 (17.50%) patients, percutaneous screw fixation 7 (17.50%), open reduction and internal fixation through palmar in 11 (27.50%) and though dorsal 15 (37.50%) cases. Time to union was ≤3 in 7 (17.50%), >3-6 months 29 (72.5%), while >6 months in 4 (10%) patients. Presence of infection was 1/40 (2.38%). Conclusion: Scaphoid fractures are more common in men and younger adults and most are presented within a week of injury. These are caused mostly by fall on outstretched hand, involving right hand and involving waist. Substantial number of cases requires open reduction with internal fixation. Mostly unite in 3-6 months.

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Surgical versus nonsurgical treatment for scaphoid waist fracture with slight or no displacement

Abstract: Supplemental Digital Content is available in the text

Cited by 13 publications

References 63 publications

Surgery versus cast immobilisation for adults with a bicortical fracture of the scaphoid waist (SWIFFT): a pragmatic, multicentre, open-label, randomised superiority trial

Surgery versus cast immobilisation for adults with a bicortical fracture of the scaphoid waist (SWIFFT): a pragmatic, multicentre, open-label, randomised superiority trial

A Retrospective Review of Differences in Complication Rates between Dorsal Percutaneous and Mini-Open Surgical Fixation of Scaphoid Fractures

Demographic and Clinical Profile of Adult Patients With Scaphoid Fractures in Population of District D.I.KHAN, Pakistan

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