Nondisplaced scaphoid fractures

Summary

Evidence from seven randomized (or quasi-randomized) controlled trials suggests that patients receiving internal screw fixation may heal more quickly and return to work sooner than patients receiving cast immobilization for treating nondisplaced scaphoid fractures. Similar rates of union in both operative and nonoperative groups were seen, and grip strength and range of motion outcomes were not significantly different between the two groups in studies reporting follow-up of 1 year or longer. Long-term studies showed a slight reduction in range of motion for operatively treated patients, but statistical significance was not uniformly reported. Two of three long-term studies reported a significant increase in incidence of osteoarthritis in the scaphotrapezial joint among operatively treated individuals. It appears that some benefits of operative management may occur within short time frames, including faster healing and quicker return to work and normal activities, however functional outcomes were similar, particularly at longer follow-up.