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SHOULD ACUTE SCAPHOID FRACTURES BE FIXED? A RANDOMISED CONTROLLED TRIAL

Background: Despite the fact that benefits and risks of early fixation of scaphoid fractures have not been well established, there is an increasing trend to recommend early internal fixation even if the fracture is not displaced.

Research question/s: Does internal fixation result in better outcomes compared with a below-elbow plaster cast in patients with minimally displaced or undisplaced bicortical fractures of the waist of the scaphoid?

Methodology:Subjects: 88 patients with minimally displaced or undisplaced bicortical fractures of the waist of the scaphoid.

Experimental procedure: Subjects were randomised to treatment with early internal fixation with use of a Herbert screw without a cast (IF = 44) or a control (CON = 44) group (immobilisation in a below-the-elbow plaster cast with the thumb left free for 8 wks). Age, sex, hand dominance, side of injury, mechanism of injury, and occupation did not differ between groups. Subjects were evaluated before and after 2, 8, 12, 26 and 52 wks.

Measures of outcome: Pain, tenderness, swelling, wrist range of movement, grip strength, symptoms and disability (Patient Evaluation Measure), and radiographic features.

Main finding/s::

• Range of motion and Patient Evaluation Measure score were also better in the IF compared with the CON group at 8 wks (corresponded to cast removal) but there were no significant differences in any of the other measures of outcome between groups: 10/44 fractures in the CON group …