Treatment of Acute Scaphoid Fractures

Abstract

Whether operative treatment is a better option than nonoperative treatment for acute nondisplaced or minimally displaced fractures of the scaphoid is controversial. The type of cast that should be used for nonoperative treatment is not known. We performed a systematic review and meta-analysis of randomized and quasirandomized trials to evaluate the effect of operative versus nonoperative treatment and the effect of different casting methods for nonoperative treatment of acute scaphoid fractures on nonunion rate, return to work, grip strength, range of wrist motion, complications, patient evaluation, and incidence of osteoarthritis. Two investigators assessed trial quality and extracted data. Operative treatment of acute nondisplaced or minimally displaced fractures of the scaphoid waist does not provide greater benefits regarding nonunion rate, return to work, grip strength, range of wrist motion, or patient satisfaction than cast immobilization; however, it causes more complications and, perhaps, a higher risk of scaphotrapezial osteoarthritis. There is no evidence from randomized trials to determine whether operative treatment is superior to nonoperative treatment for an acute proximal pole fracture of scaphoid bones. There is insufficient evidence to determine which type of cast should be used in nonoperative treatment of nondisplaced scaphoid fractures.

A Systematic Review and Meta-analysis of Randomized Controlled Trials Comparing Surgical versus Conservative Treatments for Acute Undisplaced or Minimally-Displaced Scaphoid Fractures

“…The findings of the present review are consistent with those of the systematic review and meta-analysis of Yin et al 26) that included seven articles, which were also included in our study, utilizing stricter inclusion criteria to examine randomized and quasi-randomized trials. Their final conclusion supports our conclusion that surgical management of acute nondisplaced or minimally-displaced fractures has not yet been proven to be superior to conservative management.…”

Evidence-Based Management of Acute Nondisplaced Scaphoid Waist Fractures

“…Yin et al in 2007 [2] performed a systematic review and meta-analysis of randomized and quasi-randomized trials comparing casting and surgery f forfor treatment of non-displaced scaphoid fractures. After pooling this data, there was no significant difference in union rate or time to return to work, and any surgical benefits were noted to be transient.…”

Scaphoid fractures with unusual presentations: a case series

“…Although falls onto outstretched hands are the most commonly described mechanism of scaphoid fractures, other mechanisms have been described including forced palmar flexion of the wrist and axial loading of the wrist with the hand in a fisted position [1]. Although this common wrist fracture has undergone much scrutiny, we have not found mention of cases involving a hyperpronation mechanism, which occurred with our Case #1.…”