Purpose: The aim of this study was to evaluate the effectiveness of surgical compared with conservative treatments for undisplaced or minimally-displaced acute waist scaphoid fractures.

 

Methods: s were searched for randomized controlled trials comparing surgical fixation with conservative treatment with or without possible early surgical fixation of fractures that fail to unite, in patients with acute undisplaced or minimally-displaced scaphoid waist fractures. Patient-reported functional outcome, wrist range of motion (ROM), grip strength, time to return to work, fracture , and complications were assessed. The data of the studies included was pooled using a random-effects model. Weighted and standard mean differences or relative risk were calculated for continuous or dichotomous variables, respectively. PRISMA guidelines were followed.

 

Results: Five studies were included, representing data from a total of 643 patients. Meta analysis showed that surgical treatment of nondisplaced or minimally-displaced scaphoid waist fractures results in significantly better patient-reported functional outcome, wrist ROM and grip strength at 12-weeks follow-up, but that there are no significant differences between the two  groups regarding these outcomes at 52-weeks. No significant differences were found between the two treatment approaches on fracture rate, but surgical fixation was associated with a significantly higher risk of complications.

 

Conclusions: On the management of undisplaced or minimally-displaced scaphoid waist fractures, although surgical treatment results in better functional outcomes on the short-term compared to conservative treatment, these differences decrease over recovery time with both groups showing good functional recovery. Additionally, when patients are initially treated with cast immobilization and closely monitored targeting the early detection and fixation of fractures that fail to unite, they achieve a similar overall rate of fracture avoiding surgical overtreatment and the related complications.

 

Level of Evidence: Therapeutic II

 

Keywords: Scaphoid fracture, surgical treatment, conservative treatment, systematic review, meta-analysis, randomized controlled trial.