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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<\/i>.<\/p>\n
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).<\/p>\n
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, \u22122.1; 95 percent confidence interval, \u22125.8 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).<\/p>\n
“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.<\/p>\n
Two authors disclosed financial ties to the medical device industry.<\/p>\n
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