Abstract
The scaphoid is the most commonly fractured carpal bone. Fractures affecting this bone affect young and active patients between 15 and 40 years of age. Stable scaphoid fractures are treated conservatively by plaster cast immobilization or other type of orthosis for an average period of four to 12 weeks. Failure to treat scaphoid fractures may result in avascular necrosis, nonunion, and early secondary osteoarthritis, which may result in significant economic and social impact due to the affected population, formed by young people of productive age. The management of this type of fracture varies significantly between different Institutions and orthopedic surgeons. This article describes a protocol for a systematic review that aims to evaluate the effects (benefits and harms) of conservative interventions in the treatment of scaphoid fractures in adults.
Highlights
1.1 Description of the Condition The scaphoid is an obliquely oriented bone, located on the radial face of the wrist joint, and is the only one that extends through both carpal rows, serving as a bridge between proximal and distal bones, transferring compression loads from the hand to the forearm, being fundamental in maintaining carpal stability (Yang et al, 1994)
Petheram et al (2009) identified that 57% of surgeons treat these fractures with brachial immobilizations including the thumb, 40% treat with immobilizations below the elbow and with free thumb and the remaining 3% varied the management between the two types of immobilizations; in relation to the position of the wrist, 68% of the surgeons put the wrist in a neutral position, 20% in extension and 12% in flexion position
The importance of this lesion and the clear variation in the configuration of immobilizations used in conservative treatment endorse the need for a systematic review of the best evidence present in the literature, seeking to inform about the effects of the needless treatment of scaphoid fractures
Summary
1.1 Description of the Condition The scaphoid is an obliquely oriented bone, located on the radial face of the wrist joint, and is the only one that extends through both carpal rows, serving as a bridge between proximal and distal bones, transferring compression loads from the hand to the forearm, being fundamental in maintaining carpal stability (Yang et al, 1994). 1.2 Description of the Intervention Typically, stable scaphoid fractures are treated conservatively, with plaster cast immobilization or other type of orthosis for an average period of four to 12 weeks This treatment can be performed in several ways, differing mainly regarding the inclusion or not of unaffected joints and the positioning of the wrist. The inclusion of the base of the proximal phalanx of the thumb in the so-called "scaphoid cast" may improve fracture healing through greater stabilization, the immobilization of any unaffected joint may result in increased morbidity, leading to joint stiffness (Clay et al, 1991; Karantana et al, 2006) Another issue concerns the position in which the wrist is immobilized; if in flexion (Cooney et al, 1980; Yanni et al, 1991) or slight extension (Fisk, 1970; King et al, 1982). 1.4 Objective To evaluate the effects (benefits and harms) of conservative interventions in the treatment of scaphoid fractures in adults
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