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Undisplaced scaphoid waist fractures: is 4 weeks’ immobilisation in a below-elbow cast sufficient if a week 4 CT scan suggests fracture union?From the Departments of Trauma and Orthopaedics and Radiology, Queen’s Medical Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK Correspondence: Prof. T. R. C. Davis, Department of Trauma and Orthopaedics, Queens Medical Campus, Nottingham University Hospitals, Nottingham, NG7 2UH, UK. Tel.: +44 1159 249924 Ext. 44337; fax: +44 1159 209921. E-mail:tim.davis{at}nuh.nhs.uk. This prospective study investigated a cohort of 59 scaphoid waist fractures which were treated nonoperatively in a below-elbow plaster cast for 4 weeks and then underwent a Week 4 CT scan to assess displacement and progress to union. Forty-three were classed as undisplaced and 37 of these 43 were also classed as ‘united’. All the 37 undisplaced and ‘united’ fractures united with up to 8 weeks’ cast immobilisation, including 26 which were taken out of plaster at 4 weeks and mobilised. We conclude that scaphoid waist fractures which appear to be undisplaced and united on a week 4 CT scan will unite, and may not need to be immobilised in a plaster cast for more than 4 weeks. Such a treatment policy may reduce the period of disability and time off work associated with nonoperative treatment.
Key Words: undisplaced scaphoid waist fracture • cast immobilisation • treatment time • union • nonunion • nonoperative
Journal of Hand Surgery (European Volume), Vol. 34, No. 5,
631-637 (2009) |
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