Common Wrist Fracture Does Not Need Surgical Repair in Most
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Most scaphoid wrist fractures in adults do not need to be repaired surgically, a new study finds. Outcomes from just over 400 patients with scaphoid waist fractures who were randomly assigned to receive either surgery or a plaster cast shows that the treatment with a cast is the best treatment available across the world, regardless of the pandemic. Previously it was suggested surgery would speed healing and return to activity. But there is no difference in return to work.

Scaphoid fractures accounts for 90% of all carpal fractures and 2% to 7% of all fractures. It predominantly affects young (mean age, 29), active individuals in their most productive working years. When the wrist is suddenly extended, either when putting the hand out to break a fall or when the palm is struck forcibly by an object scaphoid fracture occurs.

In a recent study, where the average age was 33 all had fracture displacement of 2mm or less. One year after the initial injury, patients were assessed on a number of factors, including wrist pain and function, bone healing, complications from treatment and number of days of work lost with a patient-rated wrist evaluation (PREW) questionnaire. There was essentially no difference between the two groups on the PREW. However, the surgery group had more potentially serious complications, including numbness, infection and newly developed complex regional pain syndrome.

Some surgeons are very aggressive and would let the athlete return to play within a week or two. While study says about using two screws rather than one to control the rotation of the fragments better. This is a critical bone in the wrist that maintains the length between hand and forearm and when it's broken and collapses the wrist can become arthritic.

source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30931-4/fulltext
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