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Screw Fixation vs. Casting for Non-Displaced Scaphoid Waist Fractures: A Meta-Analysis
Emily Volfson, MSc
1, Ahmad Essa, M.D. MPH
1, Ryan Paul, MD
1, Andrea HW Chan, MD, MA, FRCSC
2, Kevin Zuo, MD, MASc
3, Shawn Khan, M.D.
1; Jonathan Persitz, M.D.
1(1)University of Toronto, Toronto, ON, Canada, (2)Hospital for SickKids, Toronto, ON, Canada, (3)Toronto Western Hospital, University Health Network, Toronto, ON, Canada
Introduction:
This study evaluates the effectiveness of percutaneous screw fixation versus cast immobilization for non-displaced or minimally displaced scaphoid waist fractures. By addressing uncertainties in treatment approaches, it aims to provide evidence-based insights that optimize treatment strategies and patient outcomes.
Materials and Methods:
A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted through comprehensive searches of MEDLINE, Embase, CINAHL, and Cochrane databases. Studies were eligible for inclusion if they enrolled adult patients with acute, non-displaced or minimally displaced scaphoid waist fractures treated with either percutaneous screw fixation or cast immobilization. The primary outcome was fracture union, with secondary outcomes including time to union, return to work, grip strength, immobilization duration, revision surgery, and complication rates.
Results:
Six RCTs involving a total of 639 patients (315 in the surgical group and 324 in the nonsurgical group) were included. Percutaneous fixation was associated with a significantly lower non-union rate (1.6% vs. 7.1%; p = 0.002), faster time to union (7.2 vs. 11.6 weeks; p < 0.001), and earlier return to work (4.6 vs. 11.5 weeks; p < 0.001). Additionally, patients in the surgical group achieved greater grip strength (30.1 kg vs. 27.9 kg; p < 0.001) and required significantly less immobilization (0.5 vs. 8.3 weeks; p < 0.001). Despite the surgical intervention, complication rates were comparable between the two groups, indicating that the improved functional outcomes did not come at the cost of increased adverse events.
Conclusion:
Percutaneous screw fixation offers superior short-term outcomes compared to casting for non-displaced or minimally displaced scaphoid waist fractures, including reduced non-union rates, faster recovery, and enhanced functional outcomes. Future studies should focus on long-term patient-reported outcomes, healthcare costs, and the broader social and economic implications of treatment strategies.
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