Dias scaphoid fixation RCT 2005

Should acute scaphoid fractures be fixed? A randomized controlled trial.

Dias JJ, Wildin CJ, Bhowal B, et al. The Journal of bone and joint surgery. American volume 2005 · PMID 16203878 · doi:10.2106/jbjs.d.02305

Question

Does open screw fixation of undisplaced or minimally displaced scaphoid waist fractures improve outcome compared with plaster cast treatment?

Design

Single-centre randomised controlled trial in Leicester, UK.

Patients

Working-age adults with acute undisplaced or minimally displaced bicortical scaphoid waist fractures.

Intervention

Early internal fixation with a Herbert screw, without a cast

Comparison

Below-elbow plaster cast for eight weeks (thumb free)

Primary outcome

Function, grip strength, range of movement and union over the first year

Key result

Early fixation offered no lasting functional advantage over casting by one year, although some early benefits in function were seen. Non-unions in the cast group united after subsequent fixation, and surgery carried its own complications.

Limitations

Small single-centre trial with limited power for uncommon outcomes such as non-union, using an older screw design.

Impact on practice

An early UK trial challenging routine fixation of undisplaced waist fractures; it established the 'cast and fix if it fails to unite' strategy later tested definitively in SWIFFT.