Determining the success of clinical outcomes for thumb immobilization compared to no thumb immobilization in adult non-displaced, non-surgically managed scaphoid fractures: A systematic review.

Abstract

Background: In occupational therapy clinical practice there is often varied practice regarding thumb immobilization in a cast for nonsurgical management of nondisplaced or minimally displaced scaphoid fractures. The objective was to determine whether immobilization of the thumb in addition to the wrist for nonsurgical management of nondisplaced scaphoid fractures in adults is required to support good clinical outcomes including fracture union, hand function, wrist range of motion, pain, grip strength and scaphoid stability.

Methods: A systematic review of Embase, Medline, ProQuest, Scopus, Web of Science and a manual reference list search of retrieved studies was completed. Studies were included if participants were aged 16 years or older, received conservative treatment of the scaphoid fracture with immobilization, and evaluated the outcome measures of interest.

Results: Six articles were identified including four randomized control trials and two were one group pre-test-post-test crossover study designs, with methodological quality ranging from limited to strong. Limited evidence was found to support inclusion of the thumb in a cast for scaphoid management. Thumb inclusion did not promote better clinical outcomes regarding union rate and hand function. Thumb inclusion had no advantage over a no-thumb cast in relation to improving pain, grip strength, wrist range of movement and scaphoid stability.

Conclusion: Current evidence does not support immobilization of the thumb in addition to the wrist for nonsurgical management of nondisplaced scaphoid fractures by occupational therapists.