Buijze thumb immobilisation RCT

Cast immobilization with and without immobilization of the thumb for nondisplaced and minimally displaced scaphoid waist fractures: a multicenter, randomized, controlled trial

Buijze GA, Goslings JC, Rhemrev SJ, et al. The Journal of hand surgery 2014 · PMID 24582846 · doi:10.1016/j.jhsa.2013.12.039

Question

Does including the thumb in a cast improve union of non-displaced or minimally displaced scaphoid waist fractures?

Design

Multicentre randomised controlled trial in the Netherlands with CT assessment of union.

Patients

Patients with CT- or MRI-confirmed non-displaced or minimally displaced scaphoid fractures (mostly waist, with a small number of distal fractures included in error).

Intervention

Below-elbow cast excluding the thumb

Comparison

Below-elbow cast including the thumb

Primary outcome

Extent of union on CT (percentage of fracture line bridged) after 10 weeks in cast

Key result

The cast excluding the thumb produced significantly greater extent of union on CT at 10 weeks; overall union was almost universal and there were no significant differences in motion, grip, wrist scores or pain.

Limitations

Modest sample size and inclusion of some distal fractures; CT extent of bridging is a surrogate rather than a clinical outcome.

Impact on practice

Together with older UK work (Clay et al.), supports using a simple below-elbow cast without the thumb for scaphoid waist fractures, a practice widely adopted in UK fracture clinics.