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J Wrist Surg
DOI: 10.1055/a-2716-4034
Survey or Meta-Analysis

Percutaneous Screw Fixation vs. Casting for Non-Displaced or Minimally Displaced Scaphoid Waist Fractures: A Meta-Analysis of Randomized Controlled Trials

Authors

  • Emily Volfson

    1   Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

  • Ahmad Essa

    2   Division of Orthopaedic Surgery, Shamir Medical Center, Affiliated to the Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel

  • Ryan Paul

    1   Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
    3   Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, University Health Network, Toronto Western Hospital, Affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
    4   Division of Orthopaedic Surgery, Department of Surgery, Affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

  • Andrea Chan

    1   Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
    4   Division of Orthopaedic Surgery, Department of Surgery, Affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

  • Kevin J. Zuo

    1   Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
    3   Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, University Health Network, Toronto Western Hospital, Affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

  • Shawn Khan

    1   Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

  • Jonathan Persitz 

    1   Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
    2   Division of Orthopaedic Surgery, Shamir Medical Center, Affiliated to the Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
    3   Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, University Health Network, Toronto Western Hospital, Affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
    4   Division of Orthopaedic Surgery, Department of Surgery, Affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

Funding Information No funding was received for this study.
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Abstract

Purpose

The optimal treatment for non-displaced scaphoid waist fractures remains uncertain. This meta-analysis examined whether percutaneous screw fixation offers improved clinical and functional outcomes compared with cast immobilization, while also evaluating safety and the need for secondary procedures.

Materials and Methods

A systematic review of MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane databases was conducted through May 2025. Randomized controlled trials comparing percutaneous or mini-open screw fixation to cast immobilization in adults with non-displaced or minimally displaced scaphoid waist fractures were included. Six trials (n = 639; 315 surgical and 324 nonsurgical) met the inclusion criteria. Outcomes were pooled using random-effects models when substantial heterogeneity was present; otherwise, a fixed-effect model was applied. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool, and certainty of evidence was graded with Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Results

Percutaneous screw fixation was associated with a lower risk of nonunion (1.6% vs. 7.1%; risk ratio [RR] 0.22; 95% confidence interval [CI]: 0.09–0.57; p = 0.002; I 2 = 33.4%), faster time to union (mean difference −3.8 weeks; 95% CI: −5.20 to −2.44; p < 0.001), and earlier return to work (mean difference −5.3 weeks; 95% CI: −7.95 to −2.57; p < 0.001) compared with casting. Grip strength was higher (mean difference +2.2 kg; 95% CI: +2.06 to +2.36; p < 0.001), and immobilization duration was shorter (0.5 vs. 8.3 weeks; p < 0.001) with surgery. Secondary surgical intervention was less common in the fixation group (3.2% vs. 7.4%; RR 0.42; 95% CI: 0.21–0.86; p = 0.02), with similar complication rates between groups.

Conclusion

Percutaneous screw fixation yields favorable short-term outcomes compared with cast immobilization in adults with non-displaced or minimally displaced scaphoid waist fractures. These findings support its use in appropriately selected patients, while highlighting the need for standardized imaging and follow-up protocols and further study of long-term outcomes.

Level of Evidence

Level I.

Keywords

cast - percutaneous - scaphoid - screw - union

Supplementary Material



Publication History

Received: 05 August 2025

Accepted: 03 October 2025

Article published online:
27 October 2025

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