Acute fractures of the scaphoid. Treatment by cast immobilisation with the wrist in flexion or extension?

Acute fractures of the scaphoid were randomly allocated for conservative treatment in a Colles'-type plaster cast with the wrist immobilised in either 20 degrees flexion or 20 degrees extension. The position of the wrist did not influence the rate of union of the fracture (89%) but when reviewed after six months the wrists which had been immobilised in flexion had a greater restriction of extension. We recommend that acute fractures of the scaphoid should be treated in a Colles'-type cast with the wrist in slight extension.