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Question: In patients with fracture of the carpal scaphoid, how do the long-term effects of surgical treatment with fixation by a Herbert screw compare with those of conservative treatment with a short-arm plaster cast? Design: Randomized (allocation concealed), unblinded, controlled trial with a 12-year follow-up. Setting: A hospital in Stockholm, Sweden. Patients: 61 patients (mean age, 33 years) who had an acute fracture at the first radiographic examination were included (62 fractures; 79% of fractures were in men). Exclusion criteria were fractures through the tuberosity of the scaphoid or radiographic signs of delayed union or pseudarthrosis. 82% of patients (82% of fractures) were followed at 12 years. Intervention: Fractures were allocated to surgery with use of a Herbert screw (n = 32) or to conservative treatment with a short-arm plaster cast (from below the elbow to the metacarpophalangeal joints of the fingers and to the interphalangeal joint of the thumb) (n = 30). In the operative group, two surgeons used a volar approach with a tourniquet (mean operating time, 54 min). Main outcome measures: Duration of sick leave, pain and discomfort at 12 years, and functional ability of the wrist. Radiography was done in <70% of patients at
Journal of Bone and Joint Surgery – Wolters Kluwer Health
Published: Nov 1, 2001
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