Comparison of Operative and Non-Operative Treatment of Acute Undisplaced or Minimally-Displaced Scaphoid Fractures: A Meta-Analysis of Randomized Controlled Trials

BackgroundTraditionally, acute undisplaced or minimally-displaced scaphoid fractures are treated by casting in short- or long-arm casts. Although reports have shown that operative treatment is safe, effective and produces satisfactory results, outcomes from current studies comparing these two methods are questionable. The aim of this meta-analysis was to evaluate the effects of operative versus non-operative treatment for acute undisplaced or minimally-displaced scaphoid fractures in adults.MethodsComputerized searches were performed without language restrictions and all randomized controlled studies providing information on the effects of operative versus non-operative treatment on the outcomes of acute undisplaced or minimally-displaced scaphoid fractures were included. The weighted and standard mean difference (WMD and SMD) or the relative risk (RR) were calculated for continuous or dichotomous data respectively.ResultsA total of six studies reported in seven publications were included, representing data on 340 fractures. Meta-analysis indicated that operative treatment resulted in significantly better functional outcomes in the short term when compared with non-operative treatment. Consistently, patients who accepted surgery had a more rapid return to work. Further, surgery was advantageous in preventing delayed union of the fractures, a finding supported by the results of analysis of the time to fracture union. A number-needed-to-treat analysis revealed that more than 20 patients would have to undergo operative treatment to prevent one delayed union.ConclusionAcute undisplaced or minimally-displaced scaphoid fractures demonstrate faster recovery with operative treatment; however, the current meta-analysis does not provide evidence supporting the routine use of operative treatment for all acute undisplaced or minimally-displaced scaphoid fractures.背景：传统临床实践中，急性无移位或轻度移位的舟骨骨折多采用短臂或长臂石膏固定治疗。尽管已有研究证实手术治疗安全有效且可获得满意预后，但当前对比两种治疗方案的相关研究结论仍存争议。本项荟萃分析（meta-analysis）旨在评估成人急性无移位或轻度移位舟骨骨折患者接受手术与非手术治疗的临床效果差异。 方法：本研究无语言限制地开展计算机文献检索，纳入所有对比手术与非手术治疗对急性无移位或轻度移位舟骨骨折预后影响的随机对照研究（randomized controlled study）。针对连续性数据与二分类数据，分别计算加权均数差（weighted mean difference, WMD）、标准化均数差（standard mean difference, SMD）或相对危险度（relative risk, RR）。 结果：最终纳入7篇文献报道的6项研究，涵盖340例骨折病例数据。荟萃分析结果显示，与非手术治疗相比，手术治疗可显著改善患者短期功能预后；接受手术治疗的患者可更快重返工作岗位。此外，手术在预防骨折延迟愈合方面具有显著优势，这一结论得到骨折愈合时间分析结果的支持。需治数分析（number-needed-to-treat analysis）结果显示，每预防1例骨折延迟愈合，需为超过20例患者实施手术治疗。 结论：成人急性无移位或轻度移位的舟骨骨折患者接受手术治疗可实现更快康复，但本项荟萃分析并未提供证据支持对所有此类骨折患者常规采用手术治疗。