Can we avoid casting for suspected scaphoid fractures? A multicenter randomized controlled trial

Background

In cases where scaphoid fractures are suspected but initial x-rays appear normal, patients are usually put in a cast. However, only 10% of these cases actually have a fracture. To prevent unnecessary treatments, we studied whether using a bandage instead of a cast leads to similar recovery results.

Study Overview

We conducted a clinical trial involving adults who were suspected to have scaphoid fractures. These patients were randomly assigned to either a 3-day bandage or a 2-week cast. We assessed their condition at 2 weeks and again at 1 year using questionnaires and physical exams.

Key Findings

Out of 180 patients (91 received bandages and 89 got casts), only 16 were found to have actual scaphoid fractures. Importantly, there were no cases of complications like nonunion (when the bone doesn’t heal properly).

At the 3-month mark, patients with bandages showed similar recovery outcomes compared to those with casts. They also had better wrist movement after 2 weeks and reported higher satisfaction with their treatment.

Conclusions

For suspected scaphoid fractures with normal x-rays, using a bandage instead of a cast is a viable treatment option. Patients can be reevaluated after 2 weeks to ensure proper recovery.

Opportunities for Clinics

Based on these results, clinics can consider implementing bandaging as a first-line treatment for suspected scaphoid fractures. This approach can streamline care and enhance patient satisfaction.

Measurable Outcomes

Goals for clinics include:

Reducing unnecessary casting.
Improving patient satisfaction rates.
Maintaining similar recovery outcomes with less invasive treatment.

Next Steps

Clinics should start with a pilot project to track outcomes and refine treatment protocols based on these findings. Furthermore, exploring AI solutions can enhance patient management and follow-up.