![]() The epidemiology of fractures of the scaphoid. Surgical versus nonsurgical treatment for scaphoid waist fracture with slight or no displacement: A meta-analysis and systematic review. An Epidemiologic Perspective on Scaphoid Fracture Treatment and Frequency of Nonunion Surgery in the USA. Health Technol Assess 2020 24:1-270Īn infographic depicting the SWIFFT study findingsĭy CJ, and others. Surgical fixation compared with cast immobilisation for adults with a bicortical fracture of the scaphoid waist: the SWIFFT RCT. The current group of patients will be assessed five years after their initial treatment to look at longer term outcomes of arthritis and pain. Remaining questions include how the techniques compare in treating less common types of scaphoid fractures, or those with more displacement of the broken bones. In the US, surgeons now may have to justify surgery rather than plaster cast. The findings are being incorporated into UK and Canadian guidelines for treating broken wrists. ![]() Even during the SWIFFT trial, there was a shift back from surgery to simply treating with a plaster cast. Many of those sustaining a wrist fracture were not aware of implications such as arthritis if the bone is not promptly and properly healed. Researchers say their findings are timely, as there is an increasing trend towards surgery to fix a broken scaphoid bone in the wrist. It would also reduce the costs of treatment. Even so, the move to using plaster casts first would reduce risks further. The risks of surgery in relatively young and healthy men are low. Surgery to fix the scaphoid with a screw should be carried out only if the fracture does not heal in a cast. The researchers concluded that a plaster cast should be used as first-line treatment. It found the cost of surgery to the NHS was £2,350, compared to £727 for plaster cast treatment. after a year, the surgery group reported 15.6 days of lost employment, compared with 18.2 days in the plaster cast group.medical complications leading to stiffness or numbness were more common after surgery.regardless of the approach taken, very few people had a break that did not heal.after six months, and again at a year, there was no significant difference in pain, grip or wrist movement between the two groups.It found little difference in outcomes from both procedures: The study concluded that cast immobilisation is as effective as surgical fixation. The procedures were carried out by experienced surgeons and consultants across 31 NHS hospitals in England and Wales between July 2013 and July 2016. ![]() Half (219) had surgery, and half (220) had a plaster cast put on their wrist. The SWIFFT study included 439 mostly male patients aged 32-39 years. The outcomes from surgery versus plaster cast have never been comprehensively compared in terms of speed of healing, complications and pain for the patient, or cost effectiveness. This surgery was carried out because doctors thought that, with a shorter time in plaster, patients could return to work and normal activities more quickly. But since the late 1980s, surgeons have increasingly operated to repair the break with a tiny headless screw. Immobilising the wrist in a plaster cast for 6-10 weeks is generally sufficient for full healing. Young active men are the most likely to sustain this injury and could have arthritis in the wrist for the rest of their lives. But if it is does not repair normally, arthritis may develop in the wrist. ![]() Breaks across its midpoint, or waist, account for most fractures.Ī broken scaphoid bone is usually a straightforward injury. The scaphoid is the small bone on the thumb side of the wrist. It found that healing was similar with either approach but the surgical option was significantly more expensive. The Scaphoid Waist Internal Fixation for Fractures Trial (SWIFFT) compared the two ways of treating the break. However, before this study, there was little research into which method has the best outcome for patients and is most cost-effective. Traditionally, they have been healed by immobilising the wrist in a plaster cast but over the last two decades, surgeons have increasingly fixed the injury in surgery, by putting a small screw across the break. This is a plain English summary of an original research articleįractures of the scaphoid bone in the wrist are among the most common broken bone injuries. ![]()
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