Carpal Fractures -Scaphoid and Other Carpal Fractures-Conservative Treatment Versus Arthroscopic-Assisted Screw Fixation of Scaphoid Waist Fractures—A Randomized Trial With Minimum 4-Year Follow-Up

Conservative Treatment Versus Arthroscopic-Assisted Screw Fixation of Scaphoid Waist Fractures—A Randomized Trial With Minimum 4-Year Follow-Up

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In this randomized trial, the authors evaluated the clinical and radiological outcomes of conservative treatment versus arthroscopic-assisted screw fixation of acute non- or minimally displaced scaphoid waist fractures. The study included 38 patients who were either treated conservatively with a thumb spica cast or underwent surgical treatment consisting of arthroscopy and percutaneous antegrade screw fixation. The patients were followed for a median of 6 years.<br /><br />At 26 weeks, the conservatively treated group had better range of motion and had almost normal values compared to the contralateral wrist. There were no significant differences between the two groups in grip or pinch strength at any measurement point. At the 6-year follow-up, radiographic signs of arthritis in the radioscaphoid joint were more common in the surgically treated group compared to the conservative group.<br /><br />The study concludes that non- and minimally displaced scaphoid waist fractures are best treated conservatively. Although surgical treatment may provide improved short-term functional outcomes, it carries a possible increased risk of long-term arthritis. The authors recommend conservative treatment as the first choice for these types of fractures, with arthroscopic-assisted screw fixation reserved for patients who require a quick return to work or sport activities. It is important to note that this study had a small sample size and further research is needed to confirm these findings.

Keywords

randomized trial

conservative treatment

arthroscopic-assisted screw fixation

scaphoid waist fractures

thumb spica cast

surgical treatment

range of motion

grip strength

6-year follow-up

arthritis