Similar Clinical Outcomes at 1 Year with Surgical Fixation vs Casting for Scaphoid Waist Fractures .
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Surgery versus cast immobilisation for adults with a bicortical fracture of the scaphoid waist (SWIFFT): a pragmatic, multicentre, open-label, randomised superiority trial.
Lancet. 2020 Aug 8;396(10248):390-401.Four hundred and thirty-nine patients with bicortical scaphoid waist fracture were randomized to receive an open or percutaneous surgical fixation, or cast immobilization for 6-10 weeks. The primary outcome of interest was the Patient Rated Wrist Evaluation (PRWE) total score at 52 weeks post-treatment. Secondary outcomes of interest included PRWE pain and function sub-scale scores, Short Form 12 (SF-12) mental and physical component scores, degree of bone union, range of motion, grip strength, and the incidence of adverse events. Whilst significantly favourable PRWE total scores at 12 weeks, PRWE function scores at 6 and 12 weeks, and grip strength at 6 weeks were significantly in favour of the surgery group (during the period when the cast was still being worn), no significant differences were observed between the groups in all outcomes at 52 weeks. The exception included SF-12 physical component scores which were significantly in favour of the surgery group.
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