Acute fractures of the scaphoid bone: Systematic review and meta-analysis

Background: The scaphoid fractures account for 50%-80% of all carpal bone fractures in young individuals. Non-union of the fracture occurs in approximately 5%-10% of undisplaced scaphoid fractures. Current management varies significantly among different places and surgeons. Objectives: The purpose of this review is to investigate the evidence of the effectiveness and safety of various treatments of acute scaphoid fractures. Methodology: Systematic review and metanalysis of all the randomised and quasi-randomised trials comparing different treatments of acute scaphoid fractures. Results: Thirteen RCTs (Published 18 times) have met our inclusion criteria. The followings have been investigated: 1. Colles cast versus scaphoid cast. 2. Above elbow versus below elbow scaphoid cast. 3. Colles cast with the wrist in flexion versus Colles cast with the wrist in extension. 5. Operative versus non-operative treatment. 6. Union rate versus time to union. Conclusion: Scaphoid fracture can be treated by Colles cast for up to 12 weeks. The wrist should not be in flexion. There is no advantage of an above elbow cast over a below elbow cast. Operative treatment for scaphoid does not provide a higher union rate in undisplaced fractures, but may do in displaced fracture. Open approach seems to be superior to percutaneous fixation. (C) 2012 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.