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Comparing Outcomes of Surgical and Nonsurgical Management for Minimally Displaced Scaphoid Waist Fractures: A
A H M Hakami1, A A Alkhalifah2, W I AlWatban3
1Assistant Professor of Plastic Surgery-First Affiliated Hospital of Jazan University, Jazan, Saudi Arabia
Background:
Scaphoid waist fractures are among the most common carpal fractures, and their management remains debated, particularly for minimally displaced fractures. Surgical and nonsurgical treatments are widely utilized, but their comparative effectiveness lacks consensus.
Objective:
To evaluate and compare the outcomes of surgical versus nonsurgical management for minimally displaced scaphoid waist fractures.
Methods:
A comprehensive search was conducted in PubMed, Google Scholar, and the Cochrane Library to identify relevant RCTs. We identified 2936 articles during the research. 2707 articles were excluded during title and abstract screening. Seven randomized studies were selected for meta-analysis. Studies included patients with scaphoid waist fractures (<1 mm displacement) and compared surgical interventions (e.g., open reduction or percutaneous fixation) with nonsurgical treatments (e.g., plaster or brace fixation). Inclusion criteria required a follow-up duration of at least two months.
Results:
A total of seven RCTs were included in the meta-analysis, representing diverse populations and treatment modalities. The results demonstrated no significant differences between surgical and nonsurgical approaches in terms of pain scores, patient satisfaction, range of motion, grip strength, and DASH scores. However, surgical management showed a reduced time to union compared to nonsurgical treatment. The incidence of nonunion was comparable between groups.
Conclusion:
Both surgical and nonsurgical management of minimally displaced scaphoid waist fractures yield comparable outcomes across most clinical parameters, including pain relief, functional recovery, and patient satisfaction. While surgical intervention offers a faster time to union, it does not confer significant advantages in reducing non-union rates, improving grip strength, or enhancing range of motion.
