Acute Fractures of the Carpal Scaphoid-Literature Review

Abstract

Background/Methods: Scaphoid fracture is the most common fracture in carpal bone of the wrist and represents 11% of all upper extremity fractures and between 70% and 80% of all carpal fractures. In most cases, the mechanism of injury is a fall with an outstretched hand. Although closed treatment of stable fractures of the scaphoid is associated with a high rate of healing, this method requires prolonged cast immobilization, which may lead to muscle atrophy, possible joint contracture, disuse osteopenia, and potential financial hardship. Because of this, internal fixation of fractures of the scaphoid has become popular. The purpose of this review was to assess the current evidence supporting operative fixation versus casting for acute scaphoid fractures through a systematic review of the literature. Also assess if the final recommendations could be extrapolate to amateur or professional athletes. Results: Our search yielded 69 articles that met our inclusion criteria with ten studies achieving level of evidence 1 according to Oxford Center for Evidence-based Medicine, 2 achieving level 2, and 57 levels 3 and 4. Conclusion: This systematic review reveals that significant weaknesses exist in the literature with respect to the level of evidence and quality of published studies on this topic. Currently, there is insufficient evidence to support the most effective treatment for acute scaphoid fractures. We do not find randomized control trials about treatment of acute scaphoid fractures in athletes. Therefore, it is not possible to report treatment recommendations with adequate evidence-based support.