The authors compared the direct costs (physician visits, imaging, casting, surgery, therapy) and indirect costs (lost wages) of conservative versus operative treatment for non-displaced scaphoid waist fractures. Twenty-three patients were treated with short-arm cast immobilization (74 +- 28 days), and 62 patients were treated with scaphoid screw fixation. There were 2 delayed unions and 1 nonunion in the conservative treatment group, and 1 delayed union in the operative treatment group. Although direct costs were found to be greater in the operated patients, total costs (direct and indirect) were higher in the non-operated patients.
There were several recognized limitations of this study. Nevertheless, the findings were intriguing from a socioeconomic standpoint. Previous authors have reported potential benefits of addressing non-displaced scaphoid waist fractures surgically, determining both a shorter time to union and a faster return to employment activities (Bond et al, JBJS Am, 2001). Patients must understand the alternatives, including the risks and benefits of each treatment option.
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Journal of Hand Surgery