Study supports conservative treatment for scaphoid waist fractures

Ibrahim T. J Hand Surg Am. 2011; 36(11):1759-1768.

A pairwise meta-analaysis of level 1 studies examining acute minimally displaced and undisplaced scaphoid waist fractures showed no statistically significant difference in the union rates between surgically and nonsurically treated fractures, but found a significantly higher risk of complications in the surgical group.

“The cumulative evidence at present does not support routine surgical treatment, and aggressive conservative management should remain the mainstay for scaphoid waist fractures,” Talal Ibrahim, MBBS (Hons), MD, and colleagues wrote in their study abstract.

The researchers performed database searches of randomized controlled studies between 1990 and 2009 that investigated operative and conservative care of minimally displaced or undisplaced scaphoid waist fractures. They included six studies with a total of 363 patients in their pairwise meta-analysis.

While the pooled odds ratio showed a trend of higher union rates in the surgically treated cases, the difference in union rates between surgical and conservative care was not signficiantly different. The investigators also discovered no statistically signficiant differences between the treatments concerning osteoarthritis of the adjacent joints, range of motion and grip strength.

The researchers added, “The mixed-treatment network meta-analaysis showed that open (Herbert) screw fixation had a probability of 0.73 as being the best treatment method compared with percutaneous screw fixation, short arm cast and short thumb spica cast.”