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Trial reveals plaster casts as effective as surgery for common wrist fracture in young people

 

Plaster casts are just as effective at healing a common wrist fracture in young, active people as surgery, NIHR funded research finds.

The SWIFFT trial, led by researchers at University Hospitals of Leicester NHS Trust found that for a fracture of the scaphoid bone (one of eight small bones in the wrist), a plaster cast provides as good healing as surgery.

The findings are now published in the Lancet.

Fracture of the scaphoid bone is common in young, active people, caused by a fall on the hand or the hand being suddenly forced backward. The research suggests that by opting for a plaster cast, patients can avoid the risk of surgery, while hospitals can keep service delivery simple and cost effective, without compromising patient outcomes.

From 2013 to 2016, 439 patients with a scaphoid waist fracture of the wrist were enrolled from 31 NHS hospitals across the UK. Patients who agreed to take part were randomly assigned into two arms of the trial: either to have surgery to hold the broken scaphoid with a special screw, or to have the wrist held still in a plaster cast (with surgery offered after six weeks to those that were still not healed).

After one year from the initial injury, patients were measured on a number of factors, including wrist pain and function, bone healing, complications from treatment, and average days of work lost.

To assess their wrist pain and function, patients were asked to complete a questionnaire which had a total score from 0 to 100, where a higher score indicated worse pain and function. At one year, patients in the surgery group had a score of 12, compared to a score of 14 in the plaster group, showing no significant difference in patient-reported outcomes. While the average number of work days lost were comparable between the two groups (17 days for surgical patients, and 18 days for plaster cast patients).

However, patients who had surgery were assessed by the hospitals to have more complications following treatment (12%) than the plaster cast group (2%). 

The researchers also considered the health economics of surgery versus plaster cast. Over the year, the cost of surgery to the NHS was significantly higher at £2,350, compared with the cost of plaster cast treatment, which was £727 for each patient. 

Professor Joseph Dias, orthopaedic surgeon at the University Hospitals of Leicester NHS Trust and Chief Investigator for the SWIFFT trial, said: “This study confirms that putting a wrist with a broken scaphoid in a plaster cast provides as good healing as surgery, so long as the few that do not re-join are identified and fixed by the medical team. Fixing the scaphoid by surgery does not speed up healing and the time taken to return to work is the same as when a cast is used.

“With our research, patients and medical practitioners can be confident that we can treat patients with this fracture safely and effectively in a cast, resorting to surgery only when the bone doesn’t heal”.

The study was funded by the NIHR Health Technology Assessment Programme

More information about the study is available on the NIHR’s Funding & Awards website

The study ‘Surgery versus cast immobilisation for adults with a bicortical fracture of the scaphoid waist (SWIFFT): a pragmatic, multicentre, open-label, randomised superiority trial’, is available to read for free (up to 50 days) here: https://www.sciencedirect.com/science/article/pii/S0140673620309314?dgcid=coauthor