Surgical versus nonsurgical treatment for scaphoid waist fracture with slight or no displacement

BACKGROUND: Surgical or nonsurgical treatment for scaphoid waist fracture with slight or no displacement is still controversial. This study compared the efficacy of the 2 methods through meta-analysis to provide a reference for the choice of clinical treatment options. METHODS: Two individuals independently searched for relevant RCTs and cohort studies from PubMed (1946-February 2018), Embase (1946-February 2018), and Cochrane library (1997-February 2018). After quality assessment and data extraction, Stata 14 software was used for combining the effect size, testing heterogeneity, and studying bias. GRADEpro was used to rate the level of evidence. RESULTS: Ten RCTs and 4 cohort studies with 765 patients were included. No statistical difference in satisfaction, pain, and Disability of the Arm, Shoulder, and Hand score was found after surgical and nonsurgical treatments. Compared with nonsurgical treatment, surgical treatment shortened the time to union (SMD = -5.01, 95% CI: -7.47 to -2.58, P = .000), decreased the convalescence (SMD = -2.09, 95% CI: -3.08 to -1.11, P = .000), and reduced the incidence of nonunion (RR = 0.47, 95% CI: 0.24-0.90), P = .023). Subgroup analyses showed that the percutaneous fixation treatment can shorten the time to union SMD = -1.82, 95%CI (-2.22 to -1.42), P = = .000 and the convalescence (SMD = -4.26, 95%CI: -6.16 to -2.35, P = = .054), and open reduction fixation treatment can reduce the incidence of nonunion (RR = 0.20, 95%CI: 0.06-0.69, P = = .01). CONCLUSION: For scaphoid waist fractures with slight or no displacement, there was no statistical difference in patient satisfaction, pain, and The Disability of the Arm, Shoulder, and Hand scores between surgical treatment and nonsurgical treatment. Closed surgical treatment can shorten the time to union and convalescence, and open reduction can reduce the incidence of nonunion. On the basis of this conclusion, chief physicians can consider which treatment to use according to the patient's clinical situation and their subjective intention.