Treatment of Acute Scaphoid Fractures: A Systematic Review and Meta-Analysis

Suh, Nina; Benson, Eric C.; Faber, Kenneth J.; MacDermid, Joy C.; Grewal, Ruby

doi:10.1007/s11552-010-9276-6

Cited by 20 publications

(9 citation statements)

References 65 publications

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“…Previous meta-analysis and systematic reviews have lacked effective research on patient satisfaction. Suh et al [22] and Symes et al [23] only conducted a qualitative systematic evaluation and lacked a quantitative meta-analysis. Although Buijze et al [21] tried to perform quantitative analysis, they only included Bond et al's study.…”

Section: Discussionmentioning

confidence: 99%

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

Guo

et al. 2018

Medicine

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Section: Discussionmentioning

confidence: 99%

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

Guo

et al. 2018

Medicine

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“…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.…”

Section: Current Evidencementioning

confidence: 99%

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

Dias

Brealey

Cook

et al. 2020

Health Technol Assess

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Background Scaphoid fractures account for 90% of carpal fractures and occur predominantly in young men. Immediate surgical fixation of this fracture has increased. Objective To compare the clinical effectiveness and cost-effectiveness of surgical fixation with cast treatment and early fixation in adults with scaphoid waist fractures that fail to unite. Design Multicentre, pragmatic, open-label, parallel two-arm randomised controlled trial with an economic evaluation and a nested qualitative study. Setting Orthopaedic departments of 31 hospitals in England and Wales recruited from July 2013, with final follow-up in September 2017. Participants Adults (aged ≥ 16 years) presenting within 2 weeks of injury with a clear, bicortical fracture of the scaphoid waist on plain radiographs. Interventions Early surgical fixation using Conformité Européenne-marked headless compression screws. Below-elbow cast immobilisation for 6–10 weeks and urgent fixation of confirmed non-union. Main outcome measures The primary outcome and end point was the Patient-Rated Wrist Evaluation total score at 52 weeks, with a clinically relevant difference of 6 points. Secondary outcomes included Patient-Rated Wrist Evaluation pain and function subscales, Short Form questionnaire 12-items, bone union, range of movement, grip strength, complications and return to work. Results The mean age of 439 participants was 33 years; 363 participants were male (83%) and 269 participants had an undisplaced fracture (61%). The primary analysis was on 408 participants with valid Patient-Rated Wrist Evaluation outcome data for at least one post-randomisation time point (surgery, n = 203 of 219; cast, n = 205 of 220). There was no clinically relevant difference in the Patient-Rated Wrist Evaluation total score at 52 weeks: the mean score in the cast group was 14.0 (95% confidence interval 11.3 to 16.6) and in the surgery group was 11.9 (95% confidence interval 9.2 to 14.5), with an adjusted mean difference of –2.1 in favour of surgery (95% confidence interval –5.8 to 1.6; p = 0.27). The non-union rate was low (surgery group, n = 1; cast group, n = 4). Eight participants in the surgery group had a total of 11 reoperations and one participant in the cast group required a reoperation for non-union. The base-case economic analysis at 52 weeks found that surgery cost £1295 per patient more (95% confidence interval £1084 to £1504) than cast treatment. The base-case analysis of a lifetime-extrapolated model confirmed that the cast treatment pathway was more cost-effective. The nested qualitative study identified patients’ desire to have a ‘sense of recovering’, which surgeons should address at the outset. Limitation There were 17 participants who had initial cast treatment and surgery for confirmed non-union, which in 14 cases was within 6 months from randomisation and in three cases was after 6 months. Three of the four participants in the cast group who had a non-union at 52 weeks were not offered surgery. Conclusions Adult patients with an undisplaced or minimally displaced scaphoid waist fracture should have cast immobilisation and suspected non-unions immediately confirmed and urgently fixed. Patients should be followed up at 5 years to investigate the effect of partial union, degenerative arthritis, malunion and screw problems on their quality of life. Trial registration Current Controlled Trials ISRCTN67901257. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 52. See the NIHR Journals Library website for further project information.

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“…Nondisplaced acute scaphoid waist fractures can be treated conservatively in a short or long arm cast, or operatively, especially in high-demand patients or those with associated distal radius fractures. 3,70,71 Displaced scaphoid waist fractures and proximal pole fractures, 3 as well as fractures complicated by nonunion or nonunion with osteonecrosis, are usually treated operatively. 42 Transscaphoid perilunate dislocations, and other types of perilunate dislocations associated with scaphoid fractures, such is transscaphoid transcapitate perilunate dislocation, are treated with urgent closed reduction followed by operative treatment.…”

Section: Treatment Of Scaphoid Fractures and Their Complicationsmentioning

confidence: 99%

Imaging and Treatment of Scaphoid Fractures and Their Complications

Taljanovic

Karantanas

Griffith

et al. 2012

Semin Musculoskelet Radiol

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The scaphoid is the most commonly fractured carpal bone, with frequent complications that are predisposed by its anatomical location, anatomical configuration (shape and length), and vascular supply. The most common mechanism of injury is a fall onto an outstretched hand. Imaging plays a significant role in the initial evaluation and treatment of scaphoid fractures and their complications. Radiography should be the first imaging modality in the initial evaluation and follow-up of scaphoid fractures. Computed tomography with its superb spatial resolution enables better visualization and characterization of the fracture line, and the amount of displacement and angulation of the fracture fragments. Using the metal reduction artifact with computed tomography allows good follow-up of scaphoid fractures despite surgical hardware. Magnetic resonance imaging without contrast is the imaging modality of choice for depiction of radiographically occult scaphoid fracture, bone contusion, and associated soft tissue injury; contrast-enhanced imaging aids assessment of scaphoid fracture nonunion, osteonecrosis, fracture healing after bone grafting, and revitalization of the necrotic bone after bone grafting. Proper identification and classification of scaphoid fracture and its complications is necessary for appropriate treatment. This article describes the normal anatomy, mechanism of injury, and classification of stable and unstable fractures, together with the imaging and treatment algorithm of scaphoid fractures and their complications with an emphasis on magnetic resonance imaging.

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Treatment of Acute Scaphoid Fractures: A Systematic Review and Meta-Analysis

Cited by 20 publications

References 65 publications

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

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

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

Imaging and Treatment of Scaphoid Fractures and Their Complications

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