Clinical and radiological outcome of cast immobilisation versus surgical treatment of acute scaphoid fractures at a mean follow-up of 93 months

Department of Orthopaedic Surgery, University Hospitals of Leicester NHS Trust, Groby Road, Leicester, LE3 9QP, UK.
The Bone & Joint Journal (Impact Factor: 3.31). 07/2008; 90(7):899-905. DOI: 10.1302/0301-620X.90B7.20371
Source: PubMed


We report the outcome at a mean of 93 months (73 to 110) of 71 patients with an acute fracture of the scaphoid who were randomised to Herbert screw fixation (35) or below-elbow plaster cast immobilisation (36). These 71 patients represent the majority of a randomised series of 88 patients whose short-term outcome has previously been reported. Those patients available for later review were similar in age, gender and hand dominance. There was no statistical difference in symptoms and disability as assessed by the mean Patient Evaluation Measure (p = 0.4), or mean Patient-Rated Wrist Evaluation (p = 0.9), the mean range of movement of the wrist (p = 0.4), mean grip strength (p = 0.8), or mean pinch strength (p = 0.4). Radiographs were available from the final review for 59 patients. Osteoarthritic changes were seen in the scaphotrapezial and radioscaphoid joints in eight (13.5%) and six patients (10.2%), respectively. Three patients had asymptomatic lucency surrounding the screw. One non-operatively treated patient developed nonunion with avascular necrosis. In five patients who were treated non-operatively (16%) there was an abnormal scapholunate angle ( > 60 degrees ), but in four of these patients this finding was asymptomatic. No medium-term difference in function or radiological outcome was identified between the two treatment groups.

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    • "These findings are relevant for younger active patients who sustain the majority of scaphoid fractures [1]. Studies comparing the Herbert screw to cast immobilization did not identify any long term radiographic or clinical benefits to surgical fixation versus casting [14] and longer term follow up did not demonstrate significant benefits with surgical treatment [15]. Given the controversy that exists around operative fixation of the acute minimally displaced scaphoid fracture, surgeons must look closely at patient factors prior to recommending surgery or selecting a screw system. "
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