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Should acute scaphoid fractures be fixed? A randomized controlled trial.
J J Dias1, C J Wildin, B Bhowal
1Department of Orthopaedic Surgery, Glenfield Hospital, University Hospitals of Leicester, Groby Road, Leicester LE3 9QP, United Kingdom. joseph.dias@uhl-tr.nhs.uk
The Journal of Bone and Joint Surgery. American Volume
|October 6, 2005
Summary
Early surgical fixation for minimally displaced scaphoid fractures offers no significant overall benefit over conservative treatment. While surgery improved early wrist function, it did not prevent delayed union and introduced surgical risks, suggesting a more conservative approach is often preferable.
Area of Science:
- Orthopedic surgery
- Traumatology
- Sports medicine
Background:
- Increasing trend towards early internal fixation for minimally displaced scaphoid fractures.
- Lack of established benefits and risks for early fixation of scaphoid fractures.
- Study focused on working-age patients with undisplaced or minimally displaced bicortical scaphoid waist fractures.
Purpose of the Study:
- To investigate the benefits and risks of early internal fixation versus nonoperative treatment for acute scaphoid fractures.
- To compare outcomes including pain, tenderness, swelling, wrist mobility, grip strength, and functional disability.
Main Methods:
- Randomized controlled trial involving 88 patients with scaphoid fractures.
- Intervention group: Early internal fixation with a Herbert screw (44 patients).
- Control group: Nonoperative treatment with an 8-week below-elbow cast (44 patients).
- Evaluations at 2, 8, 12, 26, and 52 weeks using clinical assessments and radiographs.
Main Results:
- Operative group showed significantly better range of motion, Patient Evaluation Measure scores, and grip strength at 8 weeks.
- No significant differences in other outcome measures at any time point between groups.
- 10 nonoperative fractures had delayed union at 12 weeks, requiring treatment alteration; 13 minor complications occurred in the operative group.
Conclusions:
- Early fixation of acute scaphoid fractures demonstrated no clear overall benefit beyond reducing delayed union rates.
- Nondisplaced scaphoid fractures treated nonoperatively may lead to overtreatment and avoidable surgical risks with early fixation.
- Proposed 'aggressive conservative treatment' with careful monitoring and delayed surgical fixation if necessary for optimal union rates.