Conservative Treatment Versus Arthroscopic-Assisted Screw Fixation of Scaphoid Waist Fractures--A Randomized Trial With Minimum 4-Year Follow-Up.
OBJECTIVE
To evaluate clinical and radiological outcomes after conservative treatment and arthroscopic-assisted screw fixation of acute non- or minimally displaced scaphoid waist fractures in a randomized controlled trial.


METHODS
Consecutive patients with acute non- or minimally displaced scaphoid waist fractures were prospectively randomized to conservative or surgical treatment. All patients were screened using radiographs, computed tomography, and magnetic resonance imaging. Conservative treatment consisted of a below-elbow thumb spica cast until radiological signs of union appeared. Surgical treatment consisted of wrist arthroscopy and percutaneous antegrade screw fixation. Clinical examination, radiographs, and computed tomography were used to follow the patients. Twenty-four patients were treated conservatively and 14 patients underwent surgery. The patients were followed at regular intervals for 1 year after surgery. Twenty-one patients treated conservatively and 14 treated surgically were available for follow-up after a median of 6 years (range, 4-8 y).


RESULTS
At 26 weeks, the conservatively treated group had significantly better range of motion and had reached almost normal value compared with the contralateral wrist. There were no significant differences between the 2 groups concerning grip or pinch strengths at any measure point. At follow-up after a median of 6 years, radiographic signs of arthritis in the radioscaphoid joint were more common in the surgically treated group (3 of 14) than in the conservative group (2 of 21).


CONCLUSIONS
Non- and minimally displaced scaphoid waist fractures are best treated conservatively. Operative treatment may provide an improved functional outcome in the short term but at the price of a possible increased risk of arthritis in the long term.


METHODS
Therapeutic II.
Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden. Electronic address: martin.clementson@med.lu.se.
Martin
M
Clementson
Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden.
Peter
P
Jørgsholm
Department of Radiology, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden.
Jack
J
Besjakov
Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden.
Niels
N
Thomsen
Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden.
Anders
A
Björkman
D000293:Adolescent; D000328:Adult; D001182:Arthroscopy; D001863:Bone Screws; D002370:Casts, Surgical; D003952:Diagnostic Imaging; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D021361:Scaphoid Bone / Q000293:injuries*; D014954:Wrist Injuries / Q000175:diagnosis / Q000628:therapy*
Arthroscopy; randomized trial; scaphoid fracture; screw fixation; treatment