Operative versus nonoperative treatment of acute undisplaced and minimally displaced scaphoid waist fractures-A systematic review

Introduction: Undisplaced and minimally displaced scaphoid waist fractures can be managed either operatively (percutaneous or ORIF) or non-operatively with both methods obtaining high rates of fracture union and subsequent return of function. The aim of this systematic review is to identify and evaluate the best available evidence to determine whether they should be managed operatively or non-operatively. Materials and methods: A Medline and journal hand search was performed with strict eligibility criteria to obtain the highest quality evidence from meta-analyses, randomised controlled trials (RCT) and further appraised using a scoring tool. Results: The search found 112 studies, of which 12 met the eligibility criteria for inclusion. Three level 1 RCTs, three level 2 RCTs, two meta-analyses, one economic analysis, and three retrospective studies were critically appraised. The evidence suggests that percutaneous fixation may result in faster union rates by approximately 5 weeks and an earlier return to sport and work by approximately 7 weeks over cast treatment. This difference is not seen when comparing ORIF with cast treatment. Although cast treatment results in a higher non-union rate than ORIF, this needs to be balanced with the 30% minor complication rate. Manual workers require significantly longer time off work than non-manual workers regardless of the method of treatment, although they did return to work sooner after ORIF than after cast treatment. Conclusion: The majority of these injuries can be treated in a cast with good results. Operative treatment should be reserved for patients unable to work in a cast and considered for most manual workers and high-level athletes. (C) 2008 Elsevier Ltd. All rights reserved.