Common wrist fracture heals well with plaster cast
Friday August 7th 2020
A common wrist fracture in young people can heal as effectively with a plaster cast as surgery, according to a UK trial reported today.
The SWIFFT trial led by University Hospitals of Leicester NHS Trust concluded that plaster casts should be used first when treating scaphoid waist fractures in the wrist, with surgery only being considered if the bone does not heal.
As part of the study, 439 adult patients with a scaphoid waist fracture of the wrist were enrolled between 2013 and 2016 from orthopaedic departments in 31 NHS hospitals across the UK.
The participants were randomly assigned into two groups: one had surgery to hold the broken scaphoid with a special screw, while the second group had their wrists held still in a plaster cast, with the offer of surgery after six weeks if the bone did not heal.
Each participant was followed up one year after the initial injury, and measured on several factors, including wrist pain and function, bone healing, complications from treatment, and average days of work lost.
Patients were asked to complete a questionnaire which had a total score of between 0 and 100, where a higher score indicated worse pain and function.
At one year, patients in the surgery group had a score of 12, compared with a score of 14 in the plaster group, and there was no significant difference in patient-reported outcomes.
They also found that there was no significant difference in the number of lost days at work, with 17 for surgical patients, and 18 for plaster cast patients, nor in the number of fractures that did not heal properly between the two patient groups – with 2% for the surgical group and 4% for the plaster cast group.
However, 12% of patients who had surgery had more complications following treatment compared with 2% of those in the plaster cast group.
Professor Joseph Dias, orthopaedic surgeon at the University Hospitals of Leicester NHS Trust and chief investigator for the SWIFFT trial, said: “This study confirms that putting a wrist with a broken scaphoid in a plaster cast provides as good healing as surgery, so long as the few that do not re-join are identified and fixed by the medical team.
“Fixing the scaphoid by surgery does not speed up healing and the time taken to return to work is the same as when a cast is used. Despite a recent rise in surgical procedures to fix scaphoid fractures, there is no evidence that surgery produces better outcomes for patients.
“With our research, patients and medical practitioners can be confident that we can treat patients with this fracture safely and effectively in a cast, resorting to surgery only when the bone doesn't heal.”
Using plaster casts is also cost effective at £727 per patient, compared to £2,350 for surgery.
The Leicester study team worked with the University of York Trials Unit on the design and delivery of the trial, which was funded by the National Institute for Health Research.
Surgery versus cast immobilisation for adults with a bicortical fracture of the scaphoid waist (SWIFFT): a pragmatic, multicentre, open-label, randomised superiority trial. Lancet 6 August 2020
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30931-4/fulltext
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