title: Percutaneous screw fixation versus conservative treatment for fractures of the waist of the scaphoid: a prospective randomised study.
abstract: We randomly allocated 60 consecutive patients with fractures of the waist of the scaphoid to percutaneous fixation with a cannulated Acutrak screw or immobilisation in a cast. The range of movement, the grip and pinch strength, the modified Green/O'Brien functional score, return to work and sports, and radiological evidence of union were evaluated at each follow-up visit. Patients were followed sequentially for one year. Those undergoing percutaneous screw fixation showed a quicker time to union (9.2 weeks vs 13.9 weeks, p < 0.001) than those treated with a cast. There was a trend towards a higher rate of nonunion in the non-operative group, although this was not statistically significant. Patients treated by operation had a more rapid return of function and to sport and full work compared with those managed conservatively. There was a very low complication rate. We recommend that all active patients should be offered percutaneous stabilisation for fractures of the waist of the scaphoid.
authors.affiliation: Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Old Dalkeith Road, Edinburgh EH16 4SU, UK. mmcqueen@staffmail.ed.ac.uk
authors.forename: M M
authors.initials: MM
authors.lastname: McQueen
authors.forename: M K
authors.initials: MK
authors.lastname: Gelbke
authors.forename: A
authors.initials: A
authors.lastname: Wakefield
authors.forename: E M
authors.initials: EM
authors.lastname: Will
authors.forename: C
authors.initials: C
authors.lastname: Gaebler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001863:Bone Screws; D002370:Casts, Surgical; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000601:surgery*; D005599:Fractures, Ununited / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020127:Recovery of Function; D021361:Scaphoid Bone / Q000293:injuries*; D016896:Treatment Outcome