Systematic Review
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Feb 18, 2019; 10(2): 101-114
Published online Feb 18, 2019. doi: 10.5312/wjo.v10.i2.101
Return to sport following scaphoid fractures: A systematic review and meta-analysis
Joaquim S Goffin, Quintin Liao, Gregory AJ Robertson
Joaquim S Goffin, Department of Orthopaedic and Trauma Surgery, Ninewells Hospital, Dundee DD2 1SY, United Kingdom
Quintin Liao, Department of Orthopaedic and Trauma Surgery, Forth Valley Royal Hospital, Larbert FK5 4WR, United Kingdom
Gregory AJ Robertson, Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Scotland EH16 4SA, United Kingdom
Author contributions: Goffin JS, Liao Q and Robertson GAJ conceived the methodology for the manuscript, performed the literature search and analysis for the study, and wrote the manuscript.
Conflict-of-interest statement: All authors have no conflicts of interest to report.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Greg AJ Robertson, BSc, MBChB, MSc, Surgeon, Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Scotland EH16 4SA, United Kingdom. greg_robertson@live.co.uk
Telephone: +44-131-2423545 Fax: +44-131-2423541
Received: September 12, 2018
Peer-review started: September 12, 2018
First decision: October 5, 2018
Revised: November 3, 2018
Accepted: January 10, 2019
Article in press: January 10, 2019
Published online: February 18, 2019
Processing time: 159 Days and 7.9 Hours
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): 1.00-1.18; P < 0.045), RTS (MD 2.3 wk; 95%CI: 0.79-3.87; P < 0.002), union rates (RR = 1.14; 95%CI: 1.01-1.28; P < 0.030) and mean times to union (MD 4.2 wk; 95%CI: 3.94-4.36; 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.

Keywords: Acute; Fracture; Scaphoid; Carpal; Return; Sport; Rate; Time

Core tip: We recorded returned rates (RRS) and return times (RTS) to sport following acute scaphoid fractures. Eleven studies were included. Seven studies reported on conservative treatment (n = 77); eight studies reported on surgical treatment (n = 83). For conservative management, RRS was 90% (69/77), and RTS was 9.6 wk. For surgical management, RRS was 98% (81/83), and RTS was 7.3 wk. On meta-analysis, RRS (P < 0.045) and RTS (P < 0.002) were significantly better for surgical management compared to conservative management. Surgical management of acute scaphoid fractures can provide significantly improved RRS and RTS compared to conservative management.