Martin Clementson1, Peter Jørgsholm2, Jack Besjakov3, Niels Thomsen2, Anders Björkman2. 1. Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden. Electronic address: martin.clementson@med.lu.se. 2. Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden. 3. Department of Radiology, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden.
Abstract
PURPOSE: To evaluate clinical and radiological outcomes after conservative treatment and arthroscopic-assisted screw fixation of acute non- or minimally displaced scaphoid waist fractures in a randomized controlled trial. METHODS:Consecutive patients with acute non- or minimally displaced scaphoid waist fractures were prospectively randomized to conservative or surgical treatment. All patients were screened using radiographs, computed tomography, and magnetic resonance imaging. Conservative treatment consisted of a below-elbow thumb spica cast until radiological signs of union appeared. Surgical treatment consisted of wrist arthroscopy and percutaneous antegrade screw fixation. Clinical examination, radiographs, and computed tomography were used to follow the patients. Twenty-four patients were treated conservatively and 14 patients underwent surgery. The patients were followed at regular intervals for 1 year after surgery. Twenty-one patients treated conservatively and 14 treated surgically were available for follow-up after a median of 6 years (range, 4-8 y). RESULTS: At 26 weeks, the conservatively treated group had significantly better range of motion and had reached almost normal value compared with the contralateral wrist. There were no significant differences between the 2 groups concerning grip or pinch strengths at any measure point. At follow-up after a median of 6 years, radiographic signs of arthritis in the radioscaphoid joint were more common in the surgically treated group (3 of 14) than in the conservative group (2 of 21). CONCLUSIONS: Non- and minimally displaced scaphoid waist fractures are best treated conservatively. Operative treatment may provide an improved functional outcome in the short term but at the price of a possible increased risk of arthritis in the long term. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.
RCT Entities:
PURPOSE: To evaluate clinical and radiological outcomes after conservative treatment and arthroscopic-assisted screw fixation of acute non- or minimally displaced scaphoid waist fractures in a randomized controlled trial. METHODS: Consecutive patients with acute non- or minimally displaced scaphoid waist fractures were prospectively randomized to conservative or surgical treatment. All patients were screened using radiographs, computed tomography, and magnetic resonance imaging. Conservative treatment consisted of a below-elbow thumb spica cast until radiological signs of union appeared. Surgical treatment consisted of wrist arthroscopy and percutaneous antegrade screw fixation. Clinical examination, radiographs, and computed tomography were used to follow the patients. Twenty-four patients were treated conservatively and 14 patients underwent surgery. The patients were followed at regular intervals for 1 year after surgery. Twenty-one patients treated conservatively and 14 treated surgically were available for follow-up after a median of 6 years (range, 4-8 y). RESULTS: At 26 weeks, the conservatively treated group had significantly better range of motion and had reached almost normal value compared with the contralateral wrist. There were no significant differences between the 2 groups concerning grip or pinch strengths at any measure point. At follow-up after a median of 6 years, radiographic signs of arthritis in the radioscaphoid joint were more common in the surgically treated group (3 of 14) than in the conservative group (2 of 21). CONCLUSIONS: Non- and minimally displaced scaphoid waist fractures are best treated conservatively. Operative treatment may provide an improved functional outcome in the short term but at the price of a possible increased risk of arthritis in the long term. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.
Authors: Joseph Dias; Stephen Brealey; Liz Cook; Caroline Fairhurst; Sebastian Hinde; Paul Leighton; Surabhi Choudhary; Matthew Costa; Catherine Hewitt; Stephen Hodgson; Laura Jefferson; Kanagaratnam Jeyapalan; Ada Keding; Matthew Northgraves; Jared Palmer; Amar Rangan; Gerry Richardson; Nicholas Taub; Garry Tew; John Thompson; David Torgerson Journal: Health Technol Assess Date: 2020-10 Impact factor: 4.014
Authors: Turki A Al-Ajmi; Khalid H Al-Faryan; Naif F Al-Kanaan; Abdulmalik A Al-Khodair; Thamer H Al-Faryan; Maher I Al-Oraini; Abdulelah F Bassas Journal: Clin Orthop Surg Date: 2018-02-27
Authors: Anne Eva J Bulstra; Tom J Crijns; Stein J Janssen; Geert A Buijze; David Ring; Ruurd L Jaarsma; Gino M M J Kerkhoffs; Miryam C Obdeijn; Job N Doornberg Journal: Arch Orthop Trauma Surg Date: 2021-07-24 Impact factor: 3.067