Clinical and radiological outcome of cast immobilisation versus surgical treatment of acute scaphoid fractures at a mean follow-up of 93 months
- 1 July 2008
- journal article
- research article
- Published by British Editorial Society of Bone & Joint Surgery in The Journal of Bone and Joint Surgery. British volume
- Vol. 90-B (7), 899-905
- https://doi.org/10.1302/0301-620x.90b7.20371
Abstract
We report the outcome at a mean of 93 months (73 to 110) of 71 patients with an acute fracture of the scaphoid who were randomised to Herbert screw fixation (35) or below-elbow plaster cast immobilisation (36). These 71 patients represent the majority of a randomised series of 88 patients whose short-term outcome has previously been reported. Those patients available for later review were similar in age, gender and hand dominance. There was no statistical difference in symptoms and disability as assessed by the mean Patient Evaluation Measure (p = 0.4), or mean Patient-Rated Wrist Evaluation (p = 0.9), the mean range of movement of the wrist (p = 0.4), mean grip strength (p = 0.8), or mean pinch strength (p = 0.4). Radiographs were available from the final review for 59 patients. Osteoarthritic changes were seen in the scaphotrapezial and radioscaphoid joints in eight (13.5%) and six patients (10.2%), respectively. Three patients had asymptomatic lucency surrounding the screw. One non-operatively treated patient developed nonunion with avascular necrosis. In five patients who were treated non-operatively (16%) there was an abnormal scapholunate angle ( > 60°), but in four of these patients this finding was asymptomatic. No medium-term difference in function or radiological outcome was identified between the two treatment groups.Keywords
This publication has 13 references indexed in Scilit:
- SHOULD ACUTE SCAPHOID FRACTURES BE FIXED?The Journal of Bone and Joint Surgery-American Volume, 2005
- Percutaneous Screw Fixation or Cast Immobilization for Nondisplaced Scaphoid FracturesThe Journal of Bone and Joint Surgery-American Volume, 2001
- Open reduction and internal fixation of acute displaced scaphoid waist fracturesThe Journal of Hand Surgery, 2001
- Fracture of the carpal scaphoidThe Journal of Bone and Joint Surgery. British volume, 2001
- Assessing the outcome of disorders of the handThe Journal of Bone and Joint Surgery. British volume, 2001
- Patient Rating of Wrist Pain and Disability: A Reliable and Valid Measurement ToolJournal of Orthopaedic Trauma, 1998
- Measurement of the scaphoid humpback deformity using longitudinal computed tomography: Intra- and interobserver variability using various measurement techniquesThe Journal of Hand Surgery, 1998
- Long-term results of fracture of the scaphoid. A follow-up study of more than thirty years.The Journal of Bone & Joint Surgery, 1994
- Need the thumb be immobilised in scaphoid fractures? A randomised prospective trialThe Journal of Bone and Joint Surgery. British volume, 1991
- Incidence of post-traumatic arthrosis after primary healing of scaphoid fractures: A clinical and radiological studyJournal of Hand Surgery (European Volume), 1990