title: A Systematic Review and Meta-Analysis Examining the Differences Between Nonsurgical Management and Percutaneous Fixation of Minimally and Nondisplaced Scaphoid Fractures.
abstract: OBJECTIVE
  The optimal management of undisplaced scaphoid fractures remains controversial. A systematic review was conducted to assess the outcomes of acute, undisplaced scaphoid fractures managed with cast immobilization versus percutaneous or miniopen screw fixation in terms of time to return to work (RTW), time to union, and morbidity.
  
  
  METHODS
  PubMed MEDLINE, Ovid MEDLINE, EMBASE, SCOPUS, and Cochrane electronic databases were searched over the period 1974 to 2015. Key words included "scaphoid fracture," "navicular fracture," "hand," "immobilization," "cast," "conservative," "percutaneous," "screw fixation," "mini open," and "minimally invasive." A 2-step review process was done by 2 independent reviewers (H.A. and J.K.) using the following criteria: (1) acute undisplaced scaphoid fracture, (2) English language, (3) RTW duration objectively reported, (5) age older than 15 years, and (5) studies with more than 10 patients. Patient demographics, duration of immobilization, time to RTW, time to union, and complications were extracted. The methodological quality of each study included was assessed independently. Meta-analysis was performed for comparative trials.
  
  
  RESULTS
  Ten studies met the inclusion criteria: 6 comparative studies and 4 case series. Patients were divided into 2 groups: cast immobilization (group 1) and percutaneous fixation (group 2). Average time to RTW was 77 days for group 1 versus 46 days for group 2. Average time to radiographic union was 79 days for group 1 versus 44 days for group 2. There was no significant difference in complication rate between the groups (7% in group 1 vs 14% in group 2).
  
  
  CONCLUSIONS
  Percutaneous fixation of acute undisplaced scaphoid fractures has union rates comparable with those of nonsurgical cast immobilization but with faster RTW and time to union without a significant difference in complication rate.
  
  
  METHODS
  Therapeutic II.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Hassan
authors.initials: H
authors.lastname: Alnaeem
authors.affiliation: Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. Electronic address: aldekhayel@gmail.com.
authors.forename: Salah
authors.initials: S
authors.lastname: Aldekhayel
authors.affiliation: Division of Plastic and Reconstructive Surgery, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Johnathan
authors.initials: J
authors.lastname: Kanevsky
authors.affiliation: Division of Plastic and Reconstructive Surgery, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada; Division of Plastic Surgery, King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia.
authors.forename: Omar Fouda
authors.initials: OF
authors.lastname: Neel
mesh_terms: D002370:Casts, Surgical; D005260:Female; D005500:Follow-Up Studies; D000072039:Fracture Dislocation / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000534:rehabilitation* / Q000601:surgery*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D062707:Return to Work / Q000706:statistics & numerical data; D018570:Risk Assessment; D021361:Scaphoid Bone / Q000293:injuries*; D016896:Treatment Outcome
keywords: Scaphoid fractures; cast immobilization; percutaneous fixation