Our Summary

This research paper discusses a trial that compared the effectiveness of surgical fixation and cast immobilisation in treating scaphoid waist fractures (a type of wrist fracture) in adults. The study involved adults who showed a specific type of wrist fracture on their X-rays, and they were randomly assigned to either undergo early surgical fixation or to have their wrist immobilised in a cast, with surgery only if the fracture failed to heal on its own. The main measure of success was the patient’s self-evaluation of their wrist after a year.

The results showed no significant difference in patient evaluations between the surgery group and the cast group. However, more patients in the surgery group experienced serious complications from the surgery, while more patients in the cast group had complications related to the cast. The number of patients who had a medical complication was similar in both groups.

The researchers concluded that adults with this type of wrist fracture should initially have their wrist immobilised in a cast, and only have surgery if the fracture fails to heal. This approach aims to avoid the risks of surgery and mostly limit the use of surgery to fixing fractures that fail to unite. The study was funded by the National Institute for Health Research Health Technology Assessment Programme.

FAQs

  1. What methods were used to treat scaphoid waist fractures in the research trial?
  2. What were the main findings of the study comparing surgical fixation and cast immobilisation for treating scaphoid waist fractures?
  3. Should surgery be the immediate treatment for adults with scaphoid waist fractures according to the study?

Doctor’s Tip

A helpful tip a doctor might tell a patient about scaphoid fracture surgery is to follow post-operative care instructions carefully to ensure proper healing and minimize the risk of complications. This may include keeping the wrist elevated, wearing a splint or cast as directed, performing prescribed exercises to regain strength and mobility, and attending follow-up appointments with the doctor. It is important to communicate any concerns or changes in symptoms to the doctor promptly for optimal recovery.

Suitable For

Overall, patients with scaphoid waist fractures are typically recommended surgery if the fracture fails to heal with conservative treatment methods such as casting. Surgery may also be recommended for patients who have certain risk factors, such as a displaced fracture, a nonunion of the fracture, or if there is concern about potential long-term complications such as arthritis. Ultimately, the decision to recommend surgery for a scaphoid fracture will depend on the specific characteristics of the fracture and the individual patient’s overall health and preferences.

Timeline

Before scaphoid fracture surgery:

  1. Patient experiences trauma or injury to the wrist, leading to pain and swelling.
  2. Patient undergoes X-rays to confirm the presence of a scaphoid fracture.
  3. Patient may be placed in a cast or splint to immobilise the wrist and allow the fracture to heal.
  4. Patient may undergo further imaging tests or follow-up appointments to monitor the healing process.
  5. If the fracture fails to heal with conservative treatment, the patient may be recommended for surgery.

After scaphoid fracture surgery:

  1. Patient undergoes surgical fixation of the scaphoid fracture, which may involve the use of screws or other hardware.
  2. Patient may experience pain, swelling, and stiffness in the wrist after surgery.
  3. Patient may require physical therapy to regain strength and range of motion in the wrist.
  4. Patient may need to follow post-operative instructions, such as wearing a splint or brace, to support the healing process.
  5. Patient may have follow-up appointments with their surgeon to monitor the healing progress and address any complications or concerns.
  6. Patient may gradually return to normal activities and may experience improved wrist function over time.

What to Ask Your Doctor

Some questions a patient should ask their doctor about scaphoid fracture surgery include:

  1. What are the risks and benefits of undergoing surgery for my scaphoid fracture compared to immobilisation in a cast?
  2. How likely is it that my scaphoid fracture will heal on its own without surgery?
  3. What are the potential complications of scaphoid fracture surgery, and how common are they?
  4. What is the recovery process like after scaphoid fracture surgery, and how long will it take for me to regain full function of my wrist?
  5. Are there any alternative treatments or approaches to surgery that I should consider?
  6. How experienced are you in performing scaphoid fracture surgery, and what is your success rate with this procedure?
  7. Will I need physical therapy after surgery, and what are the expectations for my long-term outcome?
  8. How can I best prepare for surgery, and what can I expect during the post-operative period?
  9. Are there any specific lifestyle changes or modifications I should make during the recovery process to promote healing?
  10. What is the likelihood of the scaphoid fracture reoccurring in the future, and what steps can I take to prevent this from happening?

Reference

Authors: Dias JJ, Brealey SD, Fairhurst C, Amirfeyz R, Bhowal B, Blewitt N, Brewster M, Brown D, Choudhary S, Coapes C, Cook L, Costa M, Davis T, Di Mascio L, Giddins G, Hedley H, Hewitt C, Hinde S, Hobby J, Hodgson S, Jefferson L, Jeyapalan K, Johnston P, Jones J, Keding A, Leighton P, Logan A, Mason W, McAndrew A, McNab I, Muir L, Nicholl J, Northgraves M, Palmer J, Poulter R, Rahimtoola Z, Rangan A, Richards S, Richardson G, Stuart P, Taub N, Tavakkolizadeh A, Tew G, Thompson J, Torgerson D, Warwick D. Journal: Lancet. 2020 Aug 8;396(10248):390-401. doi: 10.1016/S0140-6736(20)30931-4. PMID: 32771106