Nondisplaced scaphoid fractures treated with prolonged cast immobilization
may result in temporary joint stiffness and muscle weakness in addition
to a delay in return to sports or work. Fixation of scaphoid fractures
with a percutaneous cannulated screw has resulted in a shorter time
to union and to return to work or sports. The purpose of this prospective,
randomized study was to compare cast immobilization with percutaneous
cannulated screw fixation of nondisplaced scaphoid fractures with
respect to time to radiographic union and to return to work.
Twenty-five full-time military personnel with an acute nondisplaced
fracture of the scaphoid waist consented to be randomized to either
cast immobilization or fixation with a percutaneous cannulated Acutrak
screw (Acumed, Beaverton, Oregon) for the purpose of this study.
Time to fracture union, wrist motion, grip strength, and return
to work as well as overall patient satisfaction at the time of a two-year
follow-up were evaluated.
Eleven patients were randomized to percutaneous cannulated screw
fixation, and fourteen were randomized to cast immobilization. The
average time to fracture union in the screw fixation group was seven
weeks compared with twelve weeks in the cast immobilization group
(p = 0.0003). The average time until the patients returned
to work was eight weeks compared with fifteen weeks in the cast
immobilization group (p = 0.0001). There was no significant
difference in the range of motion of the wrist or in grip strength
at the two-year follow-up evaluation. Overall patient satisfaction
was high in both groups.
Percutaneous cannulated screw fixation of nondisplaced scaphoid
fractures resulted in faster radiographic union and return to military
duty compared with cast immobilization. The specific indications for
and the risks and benefits of percutaneous screw fixation of such
fractures must be determined in larger randomized, prospective studies.