Nonoperative compared with operative treatment of acute scaphoid fractures. A randomized clinical trial.
BACKGROUND
Traditionally, acute nondisplaced scaphoid fractures have been treated nonoperatively in a cast, and the expected union rate approaches 90%. Internal fixation of nondisplaced scaphoid fractures has increased in popularity, and a union rate of 100% has been reported. The growing trend is to recommend internal fixation for the majority of acute scaphoid fractures. The true long-term benefits of this more complicated treatment modality have not yet been determined in randomized controlled trials. The purpose of this study was to compare the long-term results of operative fixation of acute scaphoid fractures with those of nonoperative treatment.


METHODS
During the period between 1992 and 1997, eighty-three patients with an acute nondisplaced or minimally displaced scaphoid fracture were randomly allocated to, and received, either nonoperative treatment with a cast or internal fixation with a Herbert screw. At a median of ten years after the injury, seventy-five (93%) of the eighty-one patients who were still alive were assessed clinically and radiographically.


RESULTS
All fractures united. A significant increase in the prevalence of osteoarthritis in the scaphotrapezial joint was found in the operatively treated group. No differences in subjective symptoms, as measured with limb-specific outcome scores, were found between the two groups. The range of motion and grip strength were greater, but not significantly greater, in the nonoperatively treated group.


CONCLUSIONS
This study did not demonstrate a true long-term benefit of internal fixation, compared with nonoperative treatment, for acute nondisplaced or minimally displaced scaphoid fractures. The long-term risks of surgery should be considered when recommending operative treatment.
Department of Hand Surgery, Uppsala University Hospital, SE-751 85 Uppsala, Sweden. bertil.vinnars@akademiska.se
Bertil
B
Vinnars
Mihai
M
Pietreanu
Ake
A
Bodestedt
Fredrik af
Fa
Ekenstam
Bengt
B
Gerdin
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001863:Bone Screws; D002370:Casts, Surgical; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000628:therapy*; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011859:Radiography; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D016896:Treatment Outcome