Global Health Asia-Pacific September 2020 September 2020 | Page 32

Medical News
Cast outperforms
surgery for some
wrist fractures
It should be the treatment of choice to reduce
complications and cost
Cast immobilisation is as effective as surgery
to treat most scaphoid fractures in the wrist,
according to new research published in The Lancet
� a piece of evidence that could make treatment safer
and cheaper for more patients.
With surgery being often carried out to fix this
common type of wrist fractures, researchers at the
University Hospitals of �eicester �HS Trust in the
U� compared the results of the two therapeutic
approaches in 4�9 patients and found that a plaster
cast should be the first-line treatment to minimise
risks and reduce healthcare cost, with surgery being
performed only when the bone doesn’t heal in a cast.
The scaphoid bone is one of the eight small bones
in the wrist and a common site of fractures, especailly
among young people. When it gets broken, surgeons
can insert a screw to unite the broken parts of the bone.
Alternatively, the affected wrist can be put in a cast that
provides a hard case to protect the bone while it heals
itself.
While one year after treatment there were no
significant differences in outcomes, pain or lost days at
work between the two groups, patients who underwent
the procedure were more likely to experience a
potentially serious complication from treatment than
people who had their wrist in a cast. Only patients
whose wrist bone didn’t heal after six weeks in a cast
received surgery to fix the fracture.
�This study confirms that putting a wrist with a
broken scaphoid in a plaster cast provides as good
healing as surgery, so long as the few that do not rejoin
are identified and fixed by the medical team. �ixing the
scaphoid by surgery does not speed up healing and the
time taken to return to work is the same as when a cast
is used. Despite a recent rise in surgical procedures to
fix scaphoid fractures, there is no evidence that surgery
produces better outcomes for patients,� said �rofessor
�oseph Dias, an orthopaedic surgeon at the University
Hospitals of �eicester �HS Trust and chief investigator
for the trial, according to Medicalxpress.
�With our research, patients and medical
practitioners can be confident that we can treat patients
with this fracture safely and effectively in a cast,
resorting to surgery only when the bone doesn’t heal.�
Opting for cast immobilisation as a first resort will
also provide a more cost-effective approach than
surgery. Indeed, the team highlighted the cost of plaster
cast treatment for each patient was just ��2�(US�9�0),
much lower than the tag price for surgery standing at
�2,��0 (US��,000).
To design and deliver the trial, the �eicester team
collaborated with the University of �ork Trials Unit.
�We are incredibly grateful to the patients who took
part in this important study, which shows with their
support what can be achieved through research to
ensure patients get the best care by informing doctors’
decision-making, which also benefits the �HS,� said
Dr Stephen �realey, trial manager in �ork, according to
Medicalxpress.
30 SEPTEMBER-OCTOBER 2020 GlobalHealthAsiaPacific.com