- Email: [email protected]
Cast Immobilization with and without Immobilization of the Thumb for Nondisplaced Scaphoid Waist Fractures: A Multi-center Randomized Controlled Trial
RESULTS There was a significant difference in the extent of union on CT at ten weeks (85% vs. 70%; p=0.048) favoring treatment with a cast excluding the thumb. The union rate was 98% overall when adhering to intention-to-treat (1 nonunion in the thumb-cast group) and 100% with nonoperative treatment; as one patient with a waist fracture treated with the thumb immobilized elected operative treatment one week after enrollment, subsequently used crutches and developed nonunion. There were no significant differences between the groups for wrist motion, grip strength, MMWS, DASH score, VAS for pain, or union.
SUMMARY POINTS Figure 2. Patient-rated pain and swelling t$POUSBDUFE3FTFBSDI1*PO/*)HSBOU #BSOFT+FXJTI)PTQJUBM 4ISJOFST)PTQJUBM 03&' ASES (Gelberman); Departmental funding without any personal relationship, NIH funding Gelberman, Yamaguchi, Galatz (separate grants), Boyer (Shrine grant) (Goldfarb) t3PZBMUZ4VQQPSU.FEBSUJT (FMCFSNBO
8PMUFST,MVXFS (FMCFSNBO (PMEGBSC
t3FMBUJPOTIJQXJUIPUIFSPSHTFOUJUJFT)FBMUIQPJOU$BQJUBM 4"#
+#+4 #EPG5SVTUFFT (Gelberman)
∙ ∙
∙
Treatment with a below-elbow cast without immobilization of the thumb results in a higher extent of union on CT at ten weeks. There was no difference in arm-specific disability between nondisplaced scaphoid waist fractures treated in a below-elbow cast including or excluding the thumb. Nondisplaced fractures of the scaphoid waist can be adequately treated in below-elbow cast without immobilization of the thumb.
REFERENCES
PAPER 30 'SJEBZ 4FQUFNCFS to1. $MJOJDBM1BQFS4FTTJPO4DBQIPJE
Cast Immobilization with and without Immobilization of the Thumb for Nondisplaced Scaphoid Waist Fractures: A Multi-center Randomized Controlled Trial
1. Clay, N. R.; Dias, J. J.; Costigan, P. S.; Gregg, P. J.; and Barton, N. J.: Need the thumb be immobilised in scaphoid fractures? A randomised prospective trial. J Bone Joint Surg Br, 73(5): 828-32, 1991. 2. Singh, H. P.; Forward, D.; Davis, T. R.; Dawson, J. S.; Oni, J. A.; and Downing, N. D.: Partial union of acute scaphoid fractures. J Hand Surg Br, 30(5): 440-5, 2005.
t$POUSBDUFE3FTFBSDI/FUIFSMBOET0SHBOJ[BUJPOGPS4DJFOUJmD3FTFBSDI #VJK[F Joint Active Systems, Biomet, Stryker, Orthopaedic Trauma Association, American Foundation for Surgery of the Hand, MGH Department of Orthopaedic Surgery (Ring) t$POTVMUJOH'FFT8SJHIU.FEJDBM 5PSOJFS "DVNFE 3JOH
t3PZBMUJFT OPODBTITVQQPSU IPOPSBSJB PSPUIFSGVOEJOHSFDFJWFEGSPN)BOE*OOPWBUJPOT Wright Medical, Skeletal Dynamics, Depuy, AO North America, AO International (Ring) t0XOFSTIJQJOUFSFTUT JODMVEJOHTUPDLPQUJPOT SFDFJWFEGSPN*MMVNJOPT .JNFEFY 3JOH
Level 2 Evidence
t Geert A. Buijze, MD
+$BSFM(PTMJOHT .% 1I% 4UFWFO3IFNSFW .% "MFYBOEFS8FFOJOH .% #BSU7BO%JKLNBO .% t%BWJE$3JOH .% 1I%
HYPOTHESIS There is no difference in union or arm-specific disability between nondisplaced scaphoid waist fractures treated in a below-elbow cast including or excluding the thumb.
METHODS Sixty-two patients with a CT or MRI-confirmed nondisplaced fracture of the scaphoid were enrolled in a prospective multi-center randomized controlled trial comparing treatment in a below-elbow cast including the thumb with a below-elbow cast excluding the thumb. There were 55 waist and 7 distal fractures. We adhered to intention-to-treat principles. The primary outcome was the extent of union on CT performed after 10 weeks of cast treatment, expressed as a percentage of the fracture line that had bridging bone by musculoskeletal radiologists blinded to treatment. Secondary study outcomes included wrist motion, grip strength, the Mayo Modified Wrist Score (MMWS), the Disabilities of the Arm, Shoulder and Hand (DASH) score, a visual analogue scale (VAS) for pain, and radiographic union at six months after injury.
24
PAPER 31 'SJEBZ 4FQUFNCFS to1. $MJOJDBM1BQFS4FTTJPO4DBQIPJE
Predicting Union and Time to Union in a Cohort of Acute Scaphoid Fractures -FWFM&WJEFODF ♦ Ruby Grewal, MSc, MD /JOB4VI .% t+PZ.BD%FSNJE 1I%
HYPOTHESIS The purpose of this study was to identify prognostic factors for non-union and time to union for conservatively treated acute scaphoid fractures using computerized tomography.
METHODS This retrospective cohort study identified cases with scaphoid CT scans from a tertiary hospital radiology database for the years 2004 - 2010. Subjects that presented >6 weeks from injury or were treated surgically were excluded. CT scans for each fracture were reviewed and the following potential predictors were collected: location, orientation of
♦ Speaker has nothing of financial value to disclose
SUMMARY POINTS Figure 2. Patient-rated pain and swelling t$POUSBDUFE3FTFBSDI1*PO/*)HSBOU #BSOFT+FXJTI)PTQJUBM 4ISJOFST)PTQJUBM 03&' ASES (Gelberman); Departmental funding without any personal relationship, NIH funding Gelberman, Yamaguchi, Galatz (separate grants), Boyer (Shrine grant) (Goldfarb) t3PZBMUZ4VQQPSU.FEBSUJT (FMCFSNBO
8PMUFST,MVXFS (FMCFSNBO (PMEGBSC
t3FMBUJPOTIJQXJUIPUIFSPSHTFOUJUJFT)FBMUIQPJOU$BQJUBM 4"#
+#+4 #EPG5SVTUFFT (Gelberman)
∙ ∙
∙
Treatment with a below-elbow cast without immobilization of the thumb results in a higher extent of union on CT at ten weeks. There was no difference in arm-specific disability between nondisplaced scaphoid waist fractures treated in a below-elbow cast including or excluding the thumb. Nondisplaced fractures of the scaphoid waist can be adequately treated in below-elbow cast without immobilization of the thumb.
REFERENCES
PAPER 30 'SJEBZ 4FQUFNCFS to1. $MJOJDBM1BQFS4FTTJPO4DBQIPJE
Cast Immobilization with and without Immobilization of the Thumb for Nondisplaced Scaphoid Waist Fractures: A Multi-center Randomized Controlled Trial
1. Clay, N. R.; Dias, J. J.; Costigan, P. S.; Gregg, P. J.; and Barton, N. J.: Need the thumb be immobilised in scaphoid fractures? A randomised prospective trial. J Bone Joint Surg Br, 73(5): 828-32, 1991. 2. Singh, H. P.; Forward, D.; Davis, T. R.; Dawson, J. S.; Oni, J. A.; and Downing, N. D.: Partial union of acute scaphoid fractures. J Hand Surg Br, 30(5): 440-5, 2005.
t$POUSBDUFE3FTFBSDI/FUIFSMBOET0SHBOJ[BUJPOGPS4DJFOUJmD3FTFBSDI #VJK[F Joint Active Systems, Biomet, Stryker, Orthopaedic Trauma Association, American Foundation for Surgery of the Hand, MGH Department of Orthopaedic Surgery (Ring) t$POTVMUJOH'FFT8SJHIU.FEJDBM 5PSOJFS "DVNFE 3JOH
t3PZBMUJFT OPODBTITVQQPSU IPOPSBSJB PSPUIFSGVOEJOHSFDFJWFEGSPN)BOE*OOPWBUJPOT Wright Medical, Skeletal Dynamics, Depuy, AO North America, AO International (Ring) t0XOFSTIJQJOUFSFTUT JODMVEJOHTUPDLPQUJPOT SFDFJWFEGSPN*MMVNJOPT .JNFEFY 3JOH
Level 2 Evidence
t Geert A. Buijze, MD
+$BSFM(PTMJOHT .% 1I% 4UFWFO3IFNSFW .% "MFYBOEFS8FFOJOH .% #BSU7BO%JKLNBO .% t%BWJE$3JOH .% 1I%
HYPOTHESIS There is no difference in union or arm-specific disability between nondisplaced scaphoid waist fractures treated in a below-elbow cast including or excluding the thumb.
METHODS Sixty-two patients with a CT or MRI-confirmed nondisplaced fracture of the scaphoid were enrolled in a prospective multi-center randomized controlled trial comparing treatment in a below-elbow cast including the thumb with a below-elbow cast excluding the thumb. There were 55 waist and 7 distal fractures. We adhered to intention-to-treat principles. The primary outcome was the extent of union on CT performed after 10 weeks of cast treatment, expressed as a percentage of the fracture line that had bridging bone by musculoskeletal radiologists blinded to treatment. Secondary study outcomes included wrist motion, grip strength, the Mayo Modified Wrist Score (MMWS), the Disabilities of the Arm, Shoulder and Hand (DASH) score, a visual analogue scale (VAS) for pain, and radiographic union at six months after injury.
24
PAPER 31 'SJEBZ 4FQUFNCFS to1. $MJOJDBM1BQFS4FTTJPO4DBQIPJE
Predicting Union and Time to Union in a Cohort of Acute Scaphoid Fractures -FWFM&WJEFODF ♦ Ruby Grewal, MSc, MD /JOB4VI .% t+PZ.BD%FSNJE 1I%
HYPOTHESIS The purpose of this study was to identify prognostic factors for non-union and time to union for conservatively treated acute scaphoid fractures using computerized tomography.
METHODS This retrospective cohort study identified cases with scaphoid CT scans from a tertiary hospital radiology database for the years 2004 - 2010. Subjects that presented >6 weeks from injury or were treated surgically were excluded. CT scans for each fracture were reviewed and the following potential predictors were collected: location, orientation of
♦ Speaker has nothing of financial value to disclose