439 patients (408 analyzed) with scaphoid fractures were randomized to receive a below-elbow cast for 6-10 weeks or surgical fixation of the fracture using standard CE marked headless compression screws. The primary outcome of interest was the Patient-Rated Wrist Evaluation (PRWE) score at 52 weeks. Additional reported outcomes included the rate of nonunion, incidence of reoperation, and cost-effectiveness analysis. The findings from the study found no significant differences in total PRWE scores at 52 weeks between the casting and fixation group. Nonunion rate was low in both groups. 11 reoperations in the fixation group and 1 reoperation in the casting group were observed. The cost-effectiveness analysis revealed casting with immediate fixation of nonunions to be the most cost-effective option.