Can we avoid casting for suspected scaphoid fractures? A multicenter randomized controlled trial

Area of Science:

• Orthopedic surgery
• Traumatology
• Evidence-based medicine

Background:

• Suspected scaphoid fractures with normal radiographs often lead to overtreatment with casting.
• Only 10% of patients with these symptoms actually have a scaphoid fracture.
• Evaluating non-operative alternatives like bandaging can reduce unnecessary casting.

Purpose of the Study:

• To compare functional outcomes of bandaging versus casting for suspected scaphoid fractures with normal initial radiographs.
• To determine if bandaging is noninferior to casting in terms of functional recovery.

Main Methods:

• A multicenter randomized controlled trial included adults with suspected scaphoid fractures and normal initial radiographs.
• Patients were randomized to receive either 3-day bandaging or 2-week casting.
• Functional outcomes were assessed using the Quick Disabilities of the Arm, Shoulder, and Hand (QDASH) score at 3 months, alongside other patient-reported outcomes and physical examinations.

Main Results:

• Bandaging was found to be noninferior to casting for functional outcomes at 3 months (adjusted estimated difference QDASH score 0.30).
• No significant differences were observed in most patient-reported function and pain scores between the two groups.
• The bandaging group showed better range of motion at 2 weeks and higher patient satisfaction.

Conclusions:

• Casting can be avoided in cases of suspected scaphoid fractures with normal initial radiographs.
• Bandaging is a viable alternative treatment option, particularly when patients are reassessed after two weeks.
• This approach helps reduce overtreatment and improve patient satisfaction.