Patient Experiences of Scaphoid Waist Fractures and their Treatment : a Qualitative Investigation

Aims. To explore individuals’ experience of a scaphoid waist fracture and its subsequent treatment. Patients and Methods. A purposive sample of 49 participants of the SWIFFT trial of initial surgery compared with plaster cast treatment for fractures of the scaphoid waist. More male participants (35/49) and more younger participants (28/49) were included. Participants were interviewed 6 weeks or 52 weeks post-recruitment to the trial, or at both time points. Interviews were semi-structured and analysed inductively to generate cross-cutting themes which typify experience of the injury and views upon the treatment options. Results. Data shows that individual circumstances might exaggerate or mitigate the limitations associated with a scaphoid fracture, and that an individual’s sense of recovery is subjective and more closely aligned with perceived functional abilities than it is with bone union. Misconceptions that surgery promises a speedier and more secure form of recovery means that some individuals, whose circumstances prescribe a need for quick return to function, express a preference for this treatment modality. Clinical consultations need to negotiate the imperfect relationship between bone union, normal function, and an individuals’ sense of recovery. Enhancing patients’ perceptions of regaining function, with removable splints and encouraging home exercise, will support satisfaction with care and discourage premature risk taking. Conclusions. Clinical decision making in the management of scaphoid fractures should recognise that personal circumstances will influence how functional limitations are experienced. It should also recognise that function overrides a concern for bone union, and that the consequences of fractures are poorly understood. Where possible clinicians should reinforce in individuals a sense that they are making progress in their recovery.