Joseph J Dias
Surgery versus cast immobilisation for adults with a bicortical fracture of the scaphoid waist (SWIFFT): a pragmatic, multicentre, open-label, randomised superiority trial
Dias, Joseph J; Brealey, Stephen D; Fairhurst, Caroline; Amirfeyz, Rouin; Bhowal, Bhaskar; Blewitt, Neil; Brewser, Mark; Brown, Daniel; Choudhary, Surabhi; Coapes, Christopher; Cook, Liz; Costa, Matthew; Davis, Timothy; DisMascio, Livio; Giddins, Grey; Hedley, Helen; Hewitt, Catherine; Hinde, Sebastian; Hobby, Jonathan; Hodgson, Stephen; Jefferson, Laura; Jeyapalan, Kanagaratnam; Jeyapalan, Phillip; Jones, Jonathon; Keding, Ada; Leighton, Paul; Logan, Andrew; Mason, Will; McAndrew, Andrew; McNab, Ian; Muir, Lindsay; Nicholl, James; Northgraves, Matthew; Palmer, Jared; Poulter, Rob; Jeyapalan, Zulfi; Rangan, Amar; Richards, Simon; Richardson, Gerry; Stuart, Paul; Taub, Nicholas; Tavakkolizadeh, Adel; Tew, Garry; Thompson, John; Torgerson, David; Warwick, David
Authors
Stephen D Brealey
Caroline Fairhurst
Rouin Amirfeyz
Bhaskar Bhowal
Neil Blewitt
Mark Brewser
Daniel Brown
Surabhi Choudhary
Christopher Coapes
Liz Cook
Matthew Costa
Timothy Davis
Livio DisMascio
Grey Giddins
Helen Hedley
Catherine Hewitt
Sebastian Hinde
Jonathan Hobby
Stephen Hodgson
Laura Jefferson
Kanagaratnam Jeyapalan
Phillip Jeyapalan
Jonathon Jones
Ada Keding
PAUL LEIGHTON PAUL.LEIGHTON@NOTTINGHAM.AC.UK
Associate Professor of Applied Health Services Research
Andrew Logan
Will Mason
Andrew McAndrew
Ian McNab
Lindsay Muir
James Nicholl
Matthew Northgraves
Jared Palmer
Rob Poulter
Zulfi Jeyapalan
Amar Rangan
Simon Richards
Gerry Richardson
Paul Stuart
Nicholas Taub
Adel Tavakkolizadeh
Garry Tew
John Thompson
David Torgerson
David Warwick
Abstract
Background
Scaphoid fractures account for 90% of carpal fractures and occur predominantly in young men. Immediate surgical fixation of this fracture has increased, in spite of insufficient evidence of improved outcomes over non-surgical management. We compared the clinical effectiveness of surgical fixation with cast immobilization and early fixation of those that fail to unite, for ≤2 mm displaced scaphoid waist fractures in adults.
Methods
This pragmatic, multicentre, open-label, parallel-group, two-arm randomised clinical trial included adults who presented to orthopaedic departments of 31 hospitals in England and Wales with a clear, bicortical fracture of the scaphoid waist on radiographs. Participants were randomly assigned to early surgical fixation or below-elbow cast immobilization followed by urgent fixation of confirmed non-union. The primary outcome was the Patient Rated Wrist Evaluation (PRWE) total score at 52 weeks post-randomisation. Registration ISRCTN67901257.
Findings
Of 439 randomised patients (mean age 33 years, 363 [83%] men), 408 (93%) were included in the primary analyses. There was no difference in PRWE score at 52 weeks (adjusted mean difference -2·1 points, 95% CI -5·8 to 1·6, p=0·27). There were no differences at 52 weeks for the PRWE pain or function subscales, the SF-12 mental component score, grip strength, or range of movement. Fewer participants in the surgery group (4, 1·8%) compared with cast immobilization (9, 4·1%), had non- or slight union at 52 weeks. Participants in the surgery group were more likely to experience a potentially serious complication. Time off work was similar.
Interpretation
Adult patients with ≤2 mm displaced scaphoid waist fracture should have initial cast immobilization and suspected non-unions immediately confirmed and urgently fixed. This will help avoid risks of surgery and mostly limit its use to fixing non-union.
Citation
Dias, J. J., Brealey, S. D., Fairhurst, C., Amirfeyz, R., Bhowal, B., Blewitt, N., …Warwick, D. (2020). Surgery versus cast immobilisation for adults with a bicortical fracture of the scaphoid waist (SWIFFT): a pragmatic, multicentre, open-label, randomised superiority trial. Lancet, 396(10248), 390-401. https://doi.org/10.1016/S0140-6736%2820%2930931-4
Journal Article Type | Article |
---|---|
Acceptance Date | Apr 22, 2020 |
Online Publication Date | Aug 8, 2020 |
Publication Date | Aug 8, 2020 |
Deposit Date | Mar 6, 2020 |
Publicly Available Date | Mar 28, 2024 |
Journal | Lancet |
Print ISSN | 0140-6736 |
Electronic ISSN | 1474-547X |
Publisher | Elsevier |
Peer Reviewed | Peer Reviewed |
Volume | 396 |
Issue | 10248 |
Pages | 390-401 |
DOI | https://doi.org/10.1016/S0140-6736%2820%2930931-4 |
Public URL | https://nottingham-repository.worktribe.com/output/4096908 |
Publisher URL | https://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2820%2930931-4/fulltext#seccestitle10 |
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Surgery compared with cast immobilization for adults with a bi-cortical fracture of the scaphoid waist (SWIFFT): a multicentre, pragmatic, open-label, parallel-group, two-arm randomised clinical trial
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