Clinical fracture of the carpal scaphoid--supportive bandage or plaster cast immobilization?

In a prospective study of 108 patients with a clinical diagnosis of fracture of the carpal scaphoid, but without radiological evidence of fracture, the patients were randomised to treatment with either a supportive bandage or a dorsal plaster cast. Four patients proved to have incomplete fractures and three to have avulsions from the scaphoid tuberosity. Two of the fractures had been suspected radiologically at the primary investigation. No complete fractures of the scaphoid were seen. The average time in plaster was 15 days and in a bandage 12.2 days. The average sick leave for manual workers was 14 days in plaster and 4 days in a bandage, a difference that represents a significant loss of productivity. Since these fractures almost always heal irrespective of treatment, they may as well be treated as a soft tissue injury with a supportive bandage.