Can we avoid casting for suspected scaphoid fractures? A multicenter randomized controlled trial

J Orthop Traumatol. 2025 Mar 5;26(1):14. doi: 10.1186/s10195-025-00822-5.

Abstract

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 , NTR7164.

Keywords: Adults; Bone; Fractures; Patient-reported outcome measures; Scaphoid bone; Wrist injuries.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Bandages*
  • Casts, Surgical*
  • Female
  • Fractures, Bone* / diagnostic imaging
  • Fractures, Bone* / therapy
  • Humans
  • Male
  • Middle Aged
  • Patient Satisfaction
  • Radiography
  • Range of Motion, Articular
  • Scaphoid Bone* / diagnostic imaging
  • Scaphoid Bone* / injuries
  • Treatment Outcome

Associated data

  • NTR/NTR7164