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| Author/Association: | Goffin JS, Liao Q, Robertson GA |
| Title: | Return to sport following scaphoid fractures: a systematic review and meta-analysis [with consumer summary] |
| Source: | World Journal of Orthopedics 2019 Feb;10(2):101-114 |
| Method: | systematic review |
| Method Score: | This is a systematic review. Systematic reviews are not rated. |
| Consumer Summary: | ARTICLE HIGHLIGHTS: RESEARCH BACKGROUND: Scaphoid fractures account for over 85% of all sport-related carpal bone fractures and are particularly common in sports involving high impact injuries to the wrist. The management of such injuries comprises both conservative and surgical techniques, as guided by fracture location and type. Athletes demonstrate a unique challenge with regards to the management of scaphoid fractures due to their requirement to return to sport as soon as able. RESEARCH MOTIVATION: Scaphoid fractures significantly impact an athlete's ability to return to sport. This topic should therefore be addressed to understand further the outcome of various treatment options and to optimise the management of these injuries. RESEARCH OBJECTIVES: To identify the available literature reporting on the sporting outcomes of both conservative and surgical management of scaphoid fractures in the athletic population. RESEARCH METHODS: A systematic review of the available literature was performed, identifying all articles reporting on return rates to sport (RRS) and return times to sport (RTS) following acute scaphoid fractures. A total of 160 acute scaphoid fractures were included for analysis. RESEARCH RESULTS: The RRS for conservative management and for surgical management were 90% and 98%, respectively. The mean RTS was lower in the surgical cohort at 7.3 wk, compared to 9.6 wk in the conservative cohort. Union rate was higher in the surgical cohort at 97% compared to 85% in the conservative cohort. On meta-analysis, surgical management of scaphoid fractures provided significantly better RRS, RTS, union rates and mean times to union as compared to conservative management. RESEARCH CONCLUSIONS: Most athletes can expect to return to sports following scaphoid fractures, with either conservative or surgical management. Surgical management did however offer improved RRS, RTS and union rates. Both treatment options remain appropriate in the management of scaphoid fractures, and patients should be counselled accordingly prior to treatment decisions. Return to sport in a cast should be discouraged due to the risk of non-union. RESEARCH PERSPECTIVES: The management of scaphoid fractures remains a challenge in the athletic population. Further well-designed studies should aim to address this topic in order to provide a better understanding of the RRS and RTS following the various treatment methods for acute scaphoid fractures in the athlete. |
| Abstract: | BACKGROUND: Scaphoid fracture is the most commonly fractured carpal bone in the athletic patient, accounting for over 85% of all sport-related carpal bone fractures, and is particularly common in sports involving high impact injuries to the wrist. The management of such injuries comprises both conservative and surgical techniques, as guided by fracture location and type. Athletes demonstrate a unique challenge with regards to the management of scaphoid fractures due to their requirement to return to sport, as soon as able. AIM: To review systemically all studies recording return to sport following scaphoid fractures, to collate information on return rates to sport (RRS) and mean return times (RTS) to sport and to determine differences in sporting outcome for the various treatment methods. METHODS: A systematic search of Medline, Embase, CINAHAL, Cochrane, Google Scholar, Physiotherapy Evidence Database, SPORTDiscus, Web of Science and Scopus was performed in August 2018 using the keywords "scaphoid", "fracture", "acute", "carpal", "athletes", "sports", "non-operative", "conservative", "operative" and "return to sport". All studies that recorded RRS and RTS following scaphoid fractures were included. RTS was recorded as the length of time from commencement of either primary conservative management or primary surgical procedure to return to sport. RESULTS: Eleven studies were included: two randomised controlled trials, six retrospective cohort studies and three case series. Seven studies reported on conservative management (n = 77), and eight studies reported on surgical management (n = 83). For conservative management, RRS was 90% (69/77), and the mean RTS was 9.6 wk. Three studies allowed to return to sport in cast (RRS 89% (25/28); RTS 1.9 wk), and four studies required completion of cast treatment prior to returning to sport (RRS 90% (44/49); RTS 13.9 wk). Four studies recorded fracture union data: Union rate 85% (47/55); mean time to union 14.0 wk. For surgical management, RRS was 98% (81/83), and RTS was 7.3 wk. Three studies reported on percutaneous screw fixation (RRS 97% (32/33); RTS 6.5 wk), and five studies reported on open reduction internal fixation (RRS 98% (49/50); RTS 7.9 wk). Six studies recorded fracture union data: union rate 97% (69/71); mean time to union 9.8 wk. On meta-analysis, RRS (RR 1.09; 95% confidence interval (CI) 1.00 to 1.18; p < 0.045), RTS (MD 2.3 wk; 95%CI 0.79 to 3.87; p < 0.002), union rates (RR 1.14; 95%CI 1.01 to 1.28; p < 0.030) and mean times to union (MD 4.2 wk; 95%CI 3.94 to 4.36; p < 0.001) were all significantly better for the surgical cohort compared to the conservative cohort. CONCLUSION: Surgical management of scaphoid fractures can provide significantly improved RRS and RTS to sport compared to conservative management. Both treatments, however, remain acceptable options, and athletes should be fully informed of the benefits and risks of both prior to deciding treatment plans. Immediate return to sport in a cast should be avoided due to the significant risk of non-union. Full text (sometimes free) may be available at these link(s):  help |
