Management of displaced fractures of the waist of the scaphoid: meta-analyses of comparative studies

The meta-analysis identified 7 studies (1401 scaphoids), investigating scaphoid fracture treatment with non-operative methods and 6 observational studies, examining operative treatment. The nonoperative trials used plaster cast treatments for both displaced and non-displaced fractures, while the operative trials identified investigated surgery versus plaster cast treatment. The outcomes were assessed for non-operative treatment of both displaced or undisplaced fractures at the waist of the scaphoid. Calculated odds ratios of nonunion with the surgical treatment compared to the plaster treatment were also assessed. Results indicated that there is a 4 times greater risk of nonunion in displaced compared to undisplaced scaphoid fractures when treated with a plaster cast. Results also showed that there is approximately 17 times the risk of nonunion when displaced scaphoid fractures are treated with a plaster cast than with surgery.