One year outcome of surgery versus cast immobilisation for adults with an acute undisplaced or minimally displaced scaphoid fracture:A meta-analysis of randomised controlled trials

Aims There has been an increasing trend for early fixation of scaphoid fractures despite uncertain evidence. We conducted a meta-analysis to evaluate up-to date evidence from randomised controlled trials (RCTs) comparing the effectiveness of non-operative and surgical treatment for acute undisplaced and minimally displaced scaphoid fractures (≤2mm displacement). Methods A systematic review of seven databases was performed from inception until the end of March 2021 to identify eligible RCTs. Reference lists of included studies were screened. No language restrictions were applied. The primary outcome was patient reported outcome measure of wrist function at 12 months. Meta-analysis was performed for function, pain, range of motion, grip strength and union. Complications are reported narratively. Results Seven RCTs were included. There was no difference in function at 12 months (Hedges’ g 0.15, 95% CI -0.02 to 0.32, p=0.08). Complication rate was higher in the operative group with more serious complications. Conclusions We found no difference in functional outcome at 12 months for scaphoid waist fractures (≤2mm displacement) treated with a cast or surgical fixation. Complication rate is higher with surgical fixation.