Fracture of the Scaphoid: A Prospective, Randomized 12-year Follow-up Comparing Operative and Conservative Treatment

Author(s): Saeden B, Tornkvist H, Ponzer S, Hoglund M

Source: J Bone Joint Surg

Summary:

This paper presents the long-term outcome of a randomized study involving 61 patients with 62 acute scaphoid fractures. Only fractures visible on the initial x-ray were included. Thirty-two fractures underwent primary open reduction and internal fixation followed by a brief period of casting (1-3 weeks). Thirty fractures were treated by application of a short-arm cast for an average of 12 weeks. Type of fracture and timing of treatment were similar between groups. Return to work was quicker in the surgical group. Nonunion occurred in one patient after surgery and two patients after cast immobilization. Two screws required removal. Range of motion was excellent in both groups (96% and 98%). Mild STT arthritis was occasionally noted on CT imaging in both groups, although more common in the surgical cases.

The majority of acute nondisplaced scaphoid fractures will heal with immobilization. While some authors recommend a long-arm cast initially, only a short arm cast was employed in this study. The 93% union rate in casted patients is consistent with the literature. This long-term follow-up provides additional evidence as to the feasibility of acute scaphoid fracture fixation. Percutaneous and arthroscopic techniques of scaphoid fracture fixation have further diminished the surgical morbidity. However, as the pendulum swings toward primary surgical management, the risks and benefits of surgery must be carefully explained to the patient.

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