JAAOS - 2026-04-15 - Journal Article
Comparing Conservative and Surgical Treatment of Acute Nondisplaced Fractures of the Scaphoid Based on Fracture Location: A Systematic Review and Meta-Analysis.
Hawkins SD, Al-Kharabsheh Y, Li J, Leary E, Nuelle JAV, London DA
Topics
Key Takeaway
In nondisplaced scaphoid fractures, surgical treatment yields fewer nonunions overall, but for proximal pole fractures specifically, nonunion rates are similarly high regardless of treatment modality across 29 included studies.
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Summary
This systematic review and meta-analysis of 29 studies compared nonunion rates for nondisplaced scaphoid fractures stratified by fracture location (proximal pole, waist, distal pole) and treatment modality (surgical vs. nonsurgical). Pooled analysis showed higher nonunion proportions with nonsurgical treatment overall, but prediction intervals overlapped and statistical significance was not established. For proximal pole fractures specifically, nonunion proportions were similar between surgical and nonsurgical subgroups, and distal pole data were critically sparse.
Key Limitation
Overlapping prediction intervals and absence of statistical significance in the primary pooled analysis mean the directional finding of fewer nonunions with surgery cannot be confirmed, limiting definitive treatment recommendations.
Original Abstract
INTRODUCTION
Treatment of nondisplaced scaphoid fractures with either nonsurgical or surgical methods ideally involves shared decision making. To date, no meta-analysis has explicitly reported differences in healing rates between fracture locations and treatment choices, making this conversation challenging. We aimed to report the nonunion risk in nondisplaced scaphoid fractures when stratified by both treatment type and fracture location.
METHODS
We searched PubMed, SCOPUS, CINAHL, SportsDiscus, HAND, Journal of Hand Surgery, and Plastic and Reconstructive Surgery for outcome studies of nonsurgical or surgical treatment of acute, nondisplaced scaphoid fractures. Meta-analyses were conducted for the pooled proportion of fracture nonunion of each fracture location and treatment modality.
RESULTS
We screened 2019 articles, and 29 were included in the final data analysis. The pooled proportion of scaphoid fracture nonunions was higher among those treated nonsurgically than surgically, although prediction intervals were overlapping and significance was not established. We found that, regardless of the treatment method, proximal fragment fractures have the highest rate of nonunion. When evaluating only proximal scaphoid fractures, the proportions of nonunion were similar between nonsurgical and surgical subgroups.
DISCUSSIONS
Our review indicates that surgical treatment results in overall fewer nonunions than nonsurgical treatment, but with overlapping prediction intervals. However, when analyzing subgroups, we found that this association is less clear for proximal scaphoid fractures. Our review highlights a distinct lack of literature on scaphoid fractures of the distal pole.
CONCLUSIONS
The results of this study can be used to inform shared decision making when discussing treatment for a nondisplaced scaphoid fracture.