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Randomized Controlled Trial
. 2025 Mar 5;26(1):14.
doi: 10.1186/s10195-025-00822-5.

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

Abigael Cohen  1 , Max Reijman  2 , Gerald A Kraan  3 , Sara J Baart  4 , Jan A N Verhaar  2 , Joost W Colaris  2 ; SUSPECT study group
Collaborators, Affiliations
Randomized Controlled Trial

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

Abigael Cohen et al. J Orthop Traumatol. .

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.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The medical ethics committee of the Erasmus MC University Medical Center approved the study protocol prior to study commencement and all subsequent amendments (MEC-2017-504). Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Below-elbow supportive bandage
Fig. 2
Fig. 2
Study flow chart. Emergency department (ED). Patient-reported outcome measures (PROM)
See this image and copyright information in PMC

References

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