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Cast Immobilization Recommended for Scaphoid Fractures

Below-elbow cast immobilization should be followed by surgery if nonunion of fracture is confirmed

MONDAY, Aug. 10, 2020 (HealthDay News) — Initial cast immobilization is recommended for adults with scaphoid waist fractures displaced by 2 mm or less, with surgery recommended for confirmed nonunions of fracture, according to a study published in the Aug. 8 issue of The Lancet.

Joseph J. Dias, M.D., from Leicester General Hospital in the United Kingdom, and colleagues conducted a multicenter open-label, randomized superiority trial involving adults aged 16 years or older who presented with a clear bicortical fracture of the scaphoid waist on radiographs. Participants were randomly assigned to receive either early surgical fixation or below-elbow cast immobilization followed by immediate fixation if nonunion of the fracture was confirmed (219 and 220 patients, respectively).

The primary analysis included 203 participants in the surgery group and 205 in the cast immobilization group. The researchers found that the mean patient-rated wrist evaluation scores did not differ significantly at 52 weeks for the surgery and cast immobilization groups (11.9 versus 14.0; adjusted mean difference, −2.1; 95 percent confidence interval, −5.8 to 1.6; P = 0.27). More participants in the surgery group had a potentially serious complication from surgery (14 versus 1 percent), while cast-related complications occurred in fewer participants in the surgery group (2 versus 18 percent). Medical complication rates were similar between the groups (both 2 percent).

“These findings are timely, as we see an increasing trend towards primary surgical fixation, which is not clearly supported by our results,” the authors write.

Two authors disclosed financial ties to the medical device industry.

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