Undisplaced scaphoid waist fractures: is 4 weeks' immobilisation in a below-elbow cast sufficient if a week 4 CT scan suggests fracture union?
This prospective study investigated a cohort of 59 scaphoid waist fractures which were treated nonoperatively in a below-elbow plaster cast for 4 weeks and then underwent a Week 4 CT scan to assess displacement and progress to union. Forty-three were classed as undisplaced and 37 of these 43 were also classed as 'united'. All the 37 undisplaced and 'united' fractures united with up to 8 weeks' cast immobilisation, including 26 which were taken out of plaster at 4 weeks and mobilised. We conclude that scaphoid waist fractures which appear to be undisplaced and united on a week 4 CT scan will unite, and may not need to be immobilised in a plaster cast for more than 4 weeks. Such a treatment policy may reduce the period of disability and time off work associated with nonoperative treatment.
Geoghegan
J M
JM
Departments of Trauma and Orthopaedics and Radiology, Queen's Medical Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Woodruff
M J
MJ
Bhatia
R
R
Dawson
J S
JS
Kerslake
R W
RW
Downing
N D
ND
Oni
J A
JA
Davis
T R C
TR
D000293:Adolescent; D000328:Adult; D000368:Aged; D002370:Casts, Surgical; D015331:Cohort Studies; D005260:Female; D005592:Fracture Fixation; D017102:Fracture Healing; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D021361:Scaphoid Bone / Q000293:injuries*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult