The value of conservative treatment versus surgery of non-displaced waist scaphoid fractures

Introduction Scaphoid fractures are the most common type of hand fracture. Traditionally, non-displaced fractures of the scaphoid have been treated conservatively, with the immobilisation of the hand with a cast; hence, surgical fixation of the fracture has become increasingly popular because of quicker re-mobilisation and return to its original function. However, this was balanced against the risk of complications of surgery of the fractures. This review article has found that there is no statistically significant benefit obtained, with both treatment methods showing equally good outcomes at the final follow-up. The aim of this review was to discuss the treatment of scaphoid fractures comparing the effectiveness of conservative treatment, with surgical intervention in non-displaced waist fractures of the scaphoid bone. Materials and methods Electronic databases, including MEDLINE, PubMed and the Cochrane Library, were searched with the keywords of ‘scaphoid fracture’, ‘waist’, ‘conservative’ and ‘surgery’. A total of 12 articles were selected for this review. Results A total of 158 articles were found during the search from the electronic databases for this review study. The numbers of articles were reduced, because of the specificity of the review article. The articles were evaluated to determine if they fulfilled the inclusion criteria to be part of this review article. The articles that included only non-displaced waist scaphoid fractures were included in this review of surgical treatment. Conclusion Both conservative and surgical treatments are used to treat non-displaced wrist fractures of the scaphoid. Studies have shown that there are no long-term benefits of this surgery compared to conservative management. However, this surgery has a transient benefit in terms of range of motion, grip strength, but at a final follow–up, both the treatment groups showed no statistical significant differences in terms of the outcome. One may prefer surgery because of the overall reduced cost, as well as an earlier return to work and mobility. However, this must be balanced by the risk of the surgical complications involved. Introduction The scaphoid bone is the most common type of fractured carpal bone. In the United States, fractures of the bone accounts for approximately 10% of the hand fractures, with an estimated incidence of 29 per 100,000 persons. Herbert A2 fractures (non-displaced unicortical waist fractures) account for 16.5% of all the scaphoid fractures1. The conventional method of treatment for the non-displaced wrist fractures is the immobilisation of the wrist with a cast for 8–12 weeks. However, the use of surgical intervention in the treatment has become increasingly popular because of the quicker recovery period. This review paper examines that which of the two treatment methods has a better outcome for the patient in terms of cost, complication risks, function, nonunion rates and patient satisfaction. Materials and methods Electronic databases, including PubMed, MEDLINE and Cochrane Library, were used in the collection of articles. The keywords used in this search included ‘scaphoid fracture’, ‘waist’, ‘conservative’ and ’surgery’. Epidemiology, pathophysiology, clinical manifestations, diagnosis and treatment were examined in this review. In addition, bibliographies of the articles that were reviewed have been screened for additional relevant articles not discovered in the electronic search.