TY - JOUR
T1 - Can we avoid casting for suspected scaphoid fractures?
T2 - A multicenter randomized controlled trial
AU - Cohen, Abigael
AU - Reijman, Max
AU - on behalf of the SUSPECT study group
AU - Kraan, Gerald A.
AU - Baart, Sara J.
AU - Verhaar, Jan A.N.
AU - Colaris, Joost W.
AU - Bosman, Willem Maarten P.F.
AU - Meerten, Kirsten F.van
AU - Bruijninckx, Milko M.M.
AU - Deijkers, Ruud L.M.
AU - Scholtens, Lenneke C.M.
AU - Greeven, Alexander P.A.
AU - Jansen, Els H.
AU - Beek, Flip van
AU - Rhemrev, Steven J.
AU - Zwaal, Peer van der
N1 - Publisher Copyright: © The Author(s) 2025.
PY - 2025/3/5
Y1 - 2025/3/5
N2 - Background: In suspected scaphoid fractures with normal initial radiographs, the usual care is casting, but only 10% of patients have scaphoid fractures. To reduce overtreatment, we evaluated whether bandaging, instead of casting, resulted in noninferior functional outcomes. Patients and methods: We included adults with suspected scaphoid fractures and normal initial radiographs at the emergency department in our multicenter randomized controlled trial. Patients were randomized to 3-day bandaging or 2-week casting. Questionnaires, physical examination, and radiographs were performed at 2 weeks and 1 year. Additional questionnaires were sent after inclusion, 6 weeks, and 3 months. Our primary outcome was the adjusted estimated difference between groups of the Quick Disabilities of the Arm, Shoulder, and Hand (QDASH) score at 3 months (natural logarithm of the margin of noninferiority = 2.0). Secondary outcomes included the QDASH score, Patient-Rated Hand/Wrist Evaluation Score, visual analog scale pain, wrist range of motion, patient satisfaction, and complications during follow-up. Results: Of the 180 patients (91 bandaging and 89 casting), 16 had scaphoid fractures and there were no scaphoid nonunions. Functional outcome in the bandaging group was noninferior at 3 months compared with the casting group [adjusted estimated difference QDASH score 0.30 (95% CI 0.02–0.62)]. All other patient-reported function and pain scores were not significantly different between groups. Range of motion at 2 weeks was better in the bandaging group, and they were more satisfied with the treatment than the casting group. Conclusions: Casting for suspected scaphoid fractures but normal initial radiographs can be avoided because bandaging seems to be an alternative treatment option when patients are reevaluated after 2 weeks. Level of evidence Level II. Trial registration Trial registered at the Trialregister on 2018-02-28 on www.trialregister.nl,
AB - Background: In suspected scaphoid fractures with normal initial radiographs, the usual care is casting, but only 10% of patients have scaphoid fractures. To reduce overtreatment, we evaluated whether bandaging, instead of casting, resulted in noninferior functional outcomes. Patients and methods: We included adults with suspected scaphoid fractures and normal initial radiographs at the emergency department in our multicenter randomized controlled trial. Patients were randomized to 3-day bandaging or 2-week casting. Questionnaires, physical examination, and radiographs were performed at 2 weeks and 1 year. Additional questionnaires were sent after inclusion, 6 weeks, and 3 months. Our primary outcome was the adjusted estimated difference between groups of the Quick Disabilities of the Arm, Shoulder, and Hand (QDASH) score at 3 months (natural logarithm of the margin of noninferiority = 2.0). Secondary outcomes included the QDASH score, Patient-Rated Hand/Wrist Evaluation Score, visual analog scale pain, wrist range of motion, patient satisfaction, and complications during follow-up. Results: Of the 180 patients (91 bandaging and 89 casting), 16 had scaphoid fractures and there were no scaphoid nonunions. Functional outcome in the bandaging group was noninferior at 3 months compared with the casting group [adjusted estimated difference QDASH score 0.30 (95% CI 0.02–0.62)]. All other patient-reported function and pain scores were not significantly different between groups. Range of motion at 2 weeks was better in the bandaging group, and they were more satisfied with the treatment than the casting group. Conclusions: Casting for suspected scaphoid fractures but normal initial radiographs can be avoided because bandaging seems to be an alternative treatment option when patients are reevaluated after 2 weeks. Level of evidence Level II. Trial registration Trial registered at the Trialregister on 2018-02-28 on www.trialregister.nl,
UR - https://www.scopus.com/pages/publications/86000619360
U2 - 10.1186/s10195-025-00822-5
DO - 10.1186/s10195-025-00822-5
M3 - Article
C2 - 40044935
AN - SCOPUS:86000619360
SN - 1590-9921
VL - 26
JO - Journal of Orthopaedics and Traumatology
JF - Journal of Orthopaedics and Traumatology
IS - 1
M1 - 14
ER -