Carpal Fractures -Scaphoid and Other Carpal Fractures-Cast Immobilization With and Without Immobilization of the Thumb for Nondisplaced and Minimally Displaced Scaphoid Waist Fractures: A Multicenter, Randomized, Controlled Trial

Cast Immobilization With and Without Immobilization of the Thumb for Nondisplaced and Minimally Displaced Scaphoid Waist Fractures: A Multicenter, Randomized, Controlled Trial

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A randomized controlled trial was conducted to compare the effectiveness of cast immobilization with and without immobilization of the thumb for nondisplaced and minimally displaced scaphoid waist fractures. A total of 62 patients were enrolled in the trial and were randomly assigned to receive a below-elbow cast including or excluding the thumb. The primary outcome of the study was the extent of union on CT performed after 10 weeks of cast treatment. Secondary outcomes included wrist motion, grip strength, Mayo Modified Wrist Score, Disabilities of the Arm, Shoulder and Hand score, and pain intensity. <br /><br />The results showed that there was a significant difference in the extent of union on CT at 10 weeks favoring treatment with a cast excluding the thumb. The overall union rate was 98% except for one patient in the thumb immobilization group who elected operative treatment and failed to heal. There were no significant differences between the groups for wrist motion, grip strength, Mayo Modified Wrist Score, Disabilities of the Arm, Shoulder, and Hand score, or pain intensity.<br /><br />Based on these findings, the study suggests that immobilization of the thumb is unnecessary for CT or MRI-confirmed nondisplaced or minimally displaced fractures of the waist of the scaphoid. The study concludes that less cumbersome approaches to immobilization may be safe and effective for the treatment of these types of fractures. Further research is recommended to confirm these findings and investigate the duration of cast wear for these fractures.

Keywords

randomized controlled trial

cast immobilization

thumb immobilization

nondisplaced fractures

minimally displaced fractures

scaphoid waist fractures

union rate

wrist motion

grip strength