title: Is Casting for Non-Displaced Simple Scaphoid Waist Fracture Effective? A CT Based Assessment of Union.
abstract: OBJECTIVE
  The purpose of this study is to report the union rate and time to union for acute non-displaced scaphoid waist fractures treated with a short arm thumb spica cast.
  
  
  METHODS
  A database was searched (2006-2013) to identify acute undisplaced scaphoid waist fractures. Cases that were not given a trial of casting were excluded (n=33). X-rays, CT scans and health records for each patient were reviewed to extract data.
  
  
  RESULTS
  172 patients met inclusion criteria. There were 138 males, 34 females, the mean age was 30 ± 16 years. The union rate was 99.4% (1 nonunion/172 subjects). The mean time to union was approximately 7.5 weeks (53 ± 37 days). Energy of injury, age or gender did not affect union rates or time to union. Cysts did not affect the union rate (p=0.73) but patients with cystic resorption along the fracture line required approximately 10 weeks for union (69 ± 60 days) compared to 7 weeks (51 ± 34 days) for those without cysts (p=0.05). Diabetes did not affect the union rate (p=0.81) but was found to increase the risk of delayed union (p=0.05). There was a weak, but statistically significant correlation between the number of days before the fracture was casted and the length of time needed to achieve union (r=0.27, p=0.001).
  
  
  CONCLUSIONS
  Non-displaced scaphoid waist fractures have a high healing rate with appropriate identification and immobilization. Follow-up CT scans to assess healing can identify union within a shorter time frame (~7 weeks) than previously reported in the literature.
authors.affiliation: Division of Orthopedic Surgery University of Western Ontario, Roth|McFarlane Hand and Upper Limb Center, St Joseph's Health Care, London, England.
authors.forename: Ruby
authors.initials: R
authors.lastname: Grewal
authors.affiliation: Division of Orthopedic Surgery University of Western Ontario, Roth|McFarlane Hand and Upper Limb Center, St Joseph's Health Care, London, England.
authors.forename: Nina
authors.initials: N
authors.lastname: Suh
authors.affiliation: Division of Orthopedic Surgery University of Western Ontario, Roth|McFarlane Hand and Upper Limb Center, St Joseph's Health Care, London, England.
authors.forename: Joy C
authors.initials: JC
authors.lastname: MacDermid
keywords: Casting; Computerized tomography; Scaphoid fracture; Union; Waist