Abstract
The benefits and risks of early fixation of scaphoid fractures were investigated in 88 patients in the working age group with clear bicortical fractures. Patients were randomised using a random number sheet into 44 who had early internal fixation using a Herbert Screw without a cast and 44 who were treated conservatively in a Colles’ type plaster cast for eight weeks. Patients were reviewed at 2,8,12,26 and 52 weeks with pain severity, tenderness, swelling, wrist movement, grip strength, the Patient Evaluation Measure (PEM) outcome score and x-rays assessed at each visit.
There was no difference between groups for age, sex, nature of injury, dominance, side injured or type of scaphoid fracture. The two groups were similar for pain severity at each of the intervals. Eight of the conservative group and one fracture in the operated group did not unite (p=0.01).
At the 8th and 12th week visits the operated group was better than those treated in a cast for wrist range, grip strength and PEM score (less is better). Thereafter there was no difference between groups.
Patients operated on returned to work at a mean of 6 weeks after their injury compared to 11 weeks for those treated conservatively. There were no serious complications, 6 patients had hypertrophic or itchy scars and one had hypoaesthesia in the palmar cutaneous branch of the median nerve distribution.
Early fixation of scaphoid fractures can be offered as an alternative to cast immobilisation with good early benefits and low risk, however the surgery can be technically difficult.
The abstracts were prepared by Mr Simon Donell. Correspondence should be addressed to him at the Department of Orthopaedics, Norfolk & Norwich Hospital, Level 4, Centre Block, Colney Lane, Norwich NR4 7UY, United Kingdom.
