The authors prospectively compare percutaneous screw fixation with cast immobilization for the treatment of non-displaced scaphoid fractures. Twenty-five full-time military personnel with an acute scaphoid fracture were treated with either a long arm thumb spica cast or percutaneous Acutrak screw fixation. Fracture union was considered complete when there was no scaphoid tenderness and trabecular bone traversed the fracture site on five different plain radiographs. The average time to fracture union and return to work were nearly half in the operatively treated group compared to the casted patients. Range of motion, grip strength, and patient satisfaction were similar and no long-term differences were noted.
This is a well designed and executed prospective randomized study in a limited patient population which confirms short-term functional advantages of percutaneous screw fixation of scaphoid fractures compared to cast immobilization. The major weakness is the diagnosis of time to union on plain roentgenograms, which are notoriously difficult to interpret. Furthermore, the Acutrak screws can obscure the fracture site. Nonetheless, this article confirms a short-term advantage of operative treatment. It should help us educate our patients on the surgical and non-surgical treatment options for this relatively common injury.