A Surgical Compared with Conservative Treatment for Acute Nondisplaced or Minimally Displaced Scaphoid Fractures: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Buijze GA, Doornberg JN, Ham JS, et al.
J Bone Joint Surg 92 (6): 1534-1544, 2010.
This article is an evidence-based systematic review and meta-analysis comparing surgical and conservative treatment for acute nondisplaced and minimally displaced scaphoid fractures. Eight randomized controlled trials comparing surgical with conservative treatment for acute nondisplaced or minimally displaced scaphoid fractures in adults were found. Data from included studies were pooled to result in 419 patients. Two hundred and seven patients were treated surgically, and 212 were treated conservatively.
The main outcome measure found was a standardized functional outcome, which significantly favored surgical treatment. Secondary parameters, including satisfaction, grip strength, time to union, and time off work, all favored surgical treatment as well. There were no significant differences between surgical and conservative treatment with regard to pain, range of motion, rates of nonunion and malunion, and total treatment costs. The complication rate was higher in the surgical treatment group (247%) than in the conservative group (9%), with a significantly higher rate of scaphotrapezial osteoarthritis in the surgical treatment group.
This study suggests that surgical treatment is favorable for acute nondisplaced and minimally displaced scaphoid fractures with regard to functional outcome and time off work. However, this treatment is also associated with a greater number of complications. Thus, long-term risks and short-term benefits of surgery should be carefully weighed in clinical decision-making.