This prospective, randomized study included eighty-three patients with an acute nondisplaced or minimally displaced scaphoid fracture randomly directed to nonoperative treatment with a short arm thumb spica cast (35) or internal fixation with a Herbert screw (40). Patient follow-up was performed at a median of 10 years in seventy-five patients (93%). One patient in the nonoperative treatment group had a delayed union at three months and was subsequently treated operatively. All other fractures healed. There were no other apparent complications in the nonoperative group. In the operatively treated group, three patients had a malpositioned screw with reactive erosion of the scaphoid. In addition, two patients had accidental partial soft tissue injury at the time of surgery (partial FCR laceration and partial laceration of the volar scapholunate ligament).
There was also one patient with sympathetically mediated pain which resolved after therapy. There were no differences in subjective symptoms as measured with limb specific outcome scores between the two groups. Range of motion and grip strength had a trend towards higher values in the nonoperatively treated group but were not significant. There was a significant increase in the prevalence of osteoarthritis in the scaphotrapezial joint in the operatively treated group.
Although previous studies have documented faster healing and return to work following operative treatment of acute nondisplaced scaphoid fractures, this study questions the long-term benefit. Despite greater immobilization in the nonoperative group, there was no significant difference in patient satisfaction or range of motion. However, there was an increased rate of minor complications in the operatively treated group and asymptomatic osteoarthritis of the scaphotrapezoidal joint. This data may be beneficial in counseling patients with an acute scaphoid fracture.