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Scaphoid (Wrist) Fractures: Surgery or Cast

Most scaphoid (bone) fractures in the wrist occur from a fall, punch, or car accident. Two treatment options are compared in this study: surgery versus casting.

One group of patients was put in a below-the-elbow case for six weeks. The second group had surgery to insert a screw to hold the bone together during healing. Results were measured using pain, grip strength, motion, and function.

The authors review the advantages and disadvantages of screw (internal fixation) versus casting the wrist. With the cast patients have a longer period of time without movement. Stiffness and loss of grip strength delay return to work or play.

Surgery has risks and complications. The bone might split when trying to put the screw in place. The hole drilled for the screw might be in the wrong place the first time requiring a second hole. With surgery there's always the risk of infection, delayed healing, and scar tissue. More serious problems such as death and permanent disability are also possible.

The results of this study show no overall benefit of early fixation with a screw compared with a wrist cast. In fact the authors suggest surgery for this problem is over treatment. Patients are exposed to additional surgical risks.

They advise other surgeons to treat conservatively with casting. Watch for signs of delay or failure to heal. Surgery may be helpful around six weeks post-injury if there isn't union of the bone.

References: J. J. Dias, MD, FRCS, et al. Should Acute Scaphoid Fractures Be Fixed? In The Journal of Bone and Joint Surgery. October 2005. Vol. 87-A. No. 10. Pp. 2160-2168.

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