One year outcome of surgery versus cast immobilisation for adults with an acute undisplaced or minimally displaced scaphoid fracture: A meta-analysis of randomised controlled trials

TY - JOUR

T1 - One year outcome of surgery versus cast immobilisation for adults with an acute undisplaced or minimally displaced scaphoid fracture

T2 - A meta-analysis of randomised controlled trials

AU - Johnson, Nick

AU - Fairhurst, Caroline Marie

AU - Brealey, Stephen Derek

AU - Cook, Liz

AU - Stirling, Euan

AU - Costa, Matthew

AU - Divall, Pip

AU - Hodgson, Stephen

AU - Rangan, Amar

AU - Dias, Joseph

N1 - © 2022 The British Editorial Society of Bone & Joint Surgery. This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy. Further copying may not be permitted; contact the publisher for details

PY - 2022/8/1

Y1 - 2022/8/1

N2 - AimsThere has been an increasing trend for early fixation of scaphoid fractures despite uncertain evidence. We conducted a meta-analysis to evaluate up-to date evidence from randomised controlled trials (RCTs) comparing the effectiveness of non-operative and surgical treatment for acute undisplaced and minimally displaced scaphoid fractures (≤2mm displacement). Methods A systematic review of seven databases was performed from inception until the end of March 2021 to identify eligible RCTs. Reference lists of included studies were screened. No language restrictions were applied. The primary outcome was patient reported outcome measure of wrist function at 12 months. Meta-analysis was performed for function, pain, range of motion, grip strength and union. Complications are reported narratively.ResultsSeven RCTs were included. There was no difference in function at 12 months (Hedges’ g 0.15, 95% CI -0.02 to 0.32, p=0.08). Complication rate was higher in the operative group with more serious complications. ConclusionsWe found no difference in functional outcome at 12 months for scaphoid waist fractures (≤2mm displacement) treated with a cast or surgical fixation. Complication rate is higher with surgical fixation.

AB - AimsThere has been an increasing trend for early fixation of scaphoid fractures despite uncertain evidence. We conducted a meta-analysis to evaluate up-to date evidence from randomised controlled trials (RCTs) comparing the effectiveness of non-operative and surgical treatment for acute undisplaced and minimally displaced scaphoid fractures (≤2mm displacement). Methods A systematic review of seven databases was performed from inception until the end of March 2021 to identify eligible RCTs. Reference lists of included studies were screened. No language restrictions were applied. The primary outcome was patient reported outcome measure of wrist function at 12 months. Meta-analysis was performed for function, pain, range of motion, grip strength and union. Complications are reported narratively.ResultsSeven RCTs were included. There was no difference in function at 12 months (Hedges’ g 0.15, 95% CI -0.02 to 0.32, p=0.08). Complication rate was higher in the operative group with more serious complications. ConclusionsWe found no difference in functional outcome at 12 months for scaphoid waist fractures (≤2mm displacement) treated with a cast or surgical fixation. Complication rate is higher with surgical fixation.

U2 - 10.1302/0301-620X.104B8.BJJ-2022-0085.R2

DO - 10.1302/0301-620X.104B8.BJJ-2022-0085.R2

M3 - Article

SN - 2049-4394

VL - 104-B

SP - 953

EP - 962

JO - The Bone and Joint journal

JF - The Bone and Joint journal

IS - 8

ER -