Suspect study

Background:

Some scaphoid fractures become visible on radiographs weeks after a trauma which makes normal radiographs directly after trauma unreliable. Untreated scaphoid fractures can lead to scaphoid non-union progressing to osteoarthritis. Therefore, the general treatment for patients with a clinically suspected scaphoid fracture and normal initial radiographs, is immobilization with below-elbow cast for 2 weeks. However, most of these patients are treated unnecessary because eventually less than 10% of them are diagnosed with an occult scaphoid fracture.

Objectives

To reduce overtreatment and costs as a result of unnecessary cast treatment in patients with a clinically suspected scaphoid fracture and normal initial radiographs, we designed a study to compare treatment with below-elbow cast or supportive bandage. We hypothesize that the functional outcome after 3 months is similar in both groups, but with lower costs in the supportive bandage group. 

The primary objective of this study is to determine if treatment with supportive bandage compared with below-elbow cast in patients with clinically suspected scaphoid fracture and normal initial radiographs, results in not inferior functional outcome after 3 months, measured with the Quick Disabilities of the Arm, Shoulder and Hand (QDASH). 

As secondary objectives, we assess whether treatment of patients with a clinically suspected scaphoid fracture with a bandage is cost-effective compared to cast. Cost-effectiveness is evaluated by medical consumption, absence from work or decreased productivity, and quality of life, measured in Quality-adjusted life years (QALYs). 

Furthermore, we assess if supportive bandage compared to cast results in not inferior pain, patient satisfaction of the received treatment, functional outcome measured with the QDASH, recovery of function measured with physical examination and the Patient Rated Wrist/Hand Evaluation (PRWHE), and quality of life.