Surgical Compared with Conservative Treatment for Acute Nondisplaced or Minimally Displaced Scaphoid Fractures
A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Geert A. Buijze, MD1, Job N. Doornberg, MD, PhD1, John S. Ham, MD, PhD2, David Ring, MD, PhD3, Mohit Bhandari, MD4 and Rudolf W. Poolman, MD, PhD2
1 Department of Orthopaedic Surgery, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. E-mail address for G.A. Buijze: g.a.buijze@amc.uva.nl
2 Department of Orthopaedic Surgery and Department of Joint Research, Onze Lieve Vrouwe Gasthuis, Postbus 95500, 1090 HM, Amsterdam, The Netherlands
3 Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114
4 Hamilton Health Sciences-General Hospital, 1200 Main Street West, Hamilton ON L8N 3Z5, Canada
doi:10.2106/JBJS.I.01214
Full Text: http://www.ejbjs.org/cgi/content/abstract/92/6/1534
Also read:
http://knee-replacement-india.blogspot.com/2009/07/36-yr-old-rt-handed-male-fell-down.html#comments
nicely balanced study…wht else to expect from bhandari et al; isnt it?..
.i dont think any of us has any debate before we read this study about the fact that a) fixing a minimally displaced scaphoid will make union easier/ earlier b) less absence of work (no cast immobilization) c) more patient satisfaction (cuz of above reason)..
..but…( and its a BIG but..) conservative management doesn’t increase the rate of non union (only time of union is increased), malunion, long term stiffness or pain (basically most of the indications for ORIF)…so personally this study doesn’t change my belief that minimally displaced scaphoids should be managed conservatively unless otherwise indicated by patient demands or surgeon bias!!!
in the same lines there’s been a study that compared the outcome of conservative Vs ORIF with LCP for distal radius fractures with similar results…
thanks to hitesh for putting up this study….
can i put a question here that i asked in JV’s blog about the above mentioned topic…would like to know how u guys feel bt it..
on one side,clinical experience and instincts that a surgeon acquires first hand (along with the bias in-built in it).. on the other side,quality workshops/seminars (not the CME hrs ones!!), good evidence based literature & “authentic” text books..now how does a surgeon weigh both of these? or in other words how much does the latter influenze the former??..or should it influenze at all (if there s a conflict between both)???
i personally believe that both should go hand in hand..you improve your skills by looking at the newer techniques and reading the literature..that will improve yourselves in the long run..