Evidence brief
Scaphoid Fracture Management: Fixation vs Casting
Surgical fixation faster return to function
Similar union rates for undisplaced fractures
Surgery may reduce nonunion risk in waist fractures
Cast immobilization remains acceptable
Patient preference and occupation influence decision
Both surgical fixation and cast immobilization are effective for undisplaced scaphoid fractures. Surgery offers faster recovery and may be preferred in active patients.
Know scaphoid blood supply (dorsal branch of radial artery, retrograde flow). Displaced fractures and proximal pole = surgery. Undisplaced waist: discuss options with patient. Herbert classification. Cast: thumb spica 8-12 weeks. Screw: headless compression screw (Herbert, Acutrak).
Buijze GA et al. Surgical compared with conservative treatment for acute nondisplaced or minimally displaced scaphoid fractures: a systematic review and meta-analysis. J Bone Joint Surg Am. 2010;92(6):1534-1544.
Level I
Systematic review of RCTs or high-quality RCT