Objective ?To determine the effectiveness and safety of surgical treatment compared to conservative treatment for adult acute nondisplaced scaphoid fractures.
Methods ?We searched the specialized trials registered in the Cochrane muscle group, The Cochrane Library (CCTR), MEDLINE (1966 to 2007), EMbase (1980 to 2007), PubMed (1966 to 2007), NRR, CCT, and CBMdisc (1979 to July 2007). We also handsearched some Chinese orthopedics journals. Randomized controlled trials (RCTs) of surgical treatment versus conservative treatment for adult acute nondisplaced scaphoid fractures were included. The extraction of data and the methodological assessment of included RCTs were performed by two reviewers independently. RevMan software was used to carry out meta-analysis.
Results ?Five RCTs including 269 patients met the inclusion criteria. Compared with conservative treatment, the time taken before returning to work or participation in sports was shorter in the surgical treatment group. Because of inadequate extraction data and heterogeneity in the included studies, the results of the time of union and grip strength were not consistent. But all the results showed favorable tendencies. No significant difference was found in wrist motion and complications between the surgical and conservative treatment groups.
Conclusion ?Compared with conservative treatment for adult acute nondisplaced scaphoid fractures, surgical treatment could decrease the time of returning to work or participation in sports, decrease the time of union, and improve grip strength. But it does not improve the wrist motion or decrease the complications. Because of the small sample size, this conclusion should further tested using well-designed, large scale RCTs.
Citation： LI Bin,YUAN Hong,BAI Jingping,XILIN Baoleri. Surgical or Conservative Treatment for Acute Nondisplaced Scaphoid Fractures in Adults: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2009, 09(8): 844-848. doi: 10.7507/1672-2531.20090149 Copy