Similar functional outcomes after treating minimally displaced or nondisplaced scaphoid waist fractures with surgery or immobilization

Reference

Johnson NA, Fairhurst C, Brealey SD, et al. One-year outcome of surgery compared with immobilization in a cast for adults with an undisplaced or minimally displaced scaphoid fracture: a meta-analysis of randomized controlled trials. Bone Joint J 2022;104-B(8):953-962.

Synopsis

These authors report that the use of urgent surgery for adults with scaphoid fractures is increasing despite uncertain evidence. So, they decided to analyze the existing evidence by searching several databases and registries and the reference lists of included studies to identify randomized trials that compared surgery with nonoperative management in adults (ie, older than 16 years) with scaphoid fractures with no more than 2 mm of displacement. The analysis focused primarily on functional outcomes after 12 months of intervention. The authors ultimately included 7 trials that enrolled between 25 and 439 participants who were an average of 30 years old (range = 15 to 75 years), 83% were men, and 98% had waist fractures of the scaphoid. Three of the studies were rated as high quality; 4 were rated as low quality. Four of the studies assessed function at 6 months and 12 months, and although the authors identified marked heterogeneity among the results, there was no difference at either of these time points on average. However, 5 studies reported nonunion rates at early follow-up (not defined by the authors); nonunion occurred in 1% of the surgically treated participants compared with 7.8% of the nonsurgically treated participants (number needed to treat = 15; 95% CI 10 - 29). Four trials reported complications (one of which reported that no complications occurred in either group). Nerve injuries, infections, or complex regional pain syndromes occurred in 9% of surgically treated participants and in 2.6% of those treated nonsurgically (number needed to treat to harm = 16). The benefits and complications are nearly identical trade-offs.