BACKGROUND: In suspected scaphoid fractures with normal initial radiographs, the usual care is casting, but only 10% of patients have scaphoid fractures. To reduce overtreatment, we evaluated whether bandaging, instead of casting, resulted in noninferior functional outcomes. PATIENTS AND METHODS: We included adults with suspected scaphoid fractures and normal initial radiographs at the emergency department in our multicenter randomized controlled trial. Patients were randomized to 3-day bandaging or 2-week casting. Questionnaires, physical examination, and radiographs were performed at 2 weeks and 1 year. Additional questionnaires were sent after inclusion, 6 weeks, and 3 months. Our primary outcome was the adjusted estimated difference between groups of the Quick Disabilities of the Arm, Shoulder, and Hand (QDASH) score at 3 months (natural logarithm of the margin of noninferiority 2.0). Secondary outcomes included the QDASH score, Patient-Rated Hand/Wrist Evaluation Score, visual analog scale pain, wrist range of motion, patient satisfaction, and complications during follow-up. RESULTS: Of the 180 patients (91 bandaging and 89 casting), 16 had scaphoid fractures and there were no scaphoid nonunions. Functional outcome in the bandaging group was noninferior at 3 months compared with the casting group (adjusted estimated difference QDASH score 0.30 (95% CI 0.02 to 0.62)). All other patient-reported function and pain scores were not significantly different between groups. Range of motion at 2 weeks was better in the bandaging group, and they were more satisfied with the treatment than the casting group. CONCLUSIONS: Casting for suspected scaphoid fractures but normal initial radiographs can be avoided because bandaging seems to be an alternative treatment option when patients are reevaluated after 2 weeks. Level of evidence Level II. TRIAL REGISTRATION: Trial registered at the Trialregister on 2018/02/28 on www.trialregister.nl, NTR7164.

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