• Hassan Alnaeem, Salah Aldekhayel, Johnathan Kanevsky, and Omar Fouda Neel.
• Division of Plastic and Reconstructive Surgery, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada.
• J Hand Surg Am. 2016 Dec 1; 41 (12): 1135-1144.e1.

PurposeThe optimal management of undisplaced scaphoid fractures remains controversial. A systematic review was conducted to assess the outcomes of acute, undisplaced scaphoid fractures managed with cast immobilization versus percutaneous or miniopen screw fixation in terms of time to return to work (RTW), time to union, and morbidity.MethodsPubMed MEDLINE, Ovid MEDLINE, EMBASE, SCOPUS, and Cochrane electronic databases were searched over the period 1974 to 2015. Key words included "scaphoid fracture," "navicular fracture," "hand," "immobilization," "cast," "conservative," "percutaneous," "screw fixation," "mini open," and "minimally invasive." A 2-step review process was done by 2 independent reviewers (H.A. and J.K.) using the following criteria: (1) acute undisplaced scaphoid fracture, (2) English language, (3) RTW duration objectively reported, (5) age older than 15 years, and (5) studies with more than 10 patients. Patient demographics, duration of immobilization, time to RTW, time to union, and complications were extracted. The methodological quality of each study included was assessed independently. Meta-analysis was performed for comparative trials.ResultsTen studies met the inclusion criteria: 6 comparative studies and 4 case series. Patients were divided into 2 groups: cast immobilization (group 1) and percutaneous fixation (group 2). Average time to RTW was 77 days for group 1 versus 46 days for group 2. Average time to radiographic union was 79 days for group 1 versus 44 days for group 2. There was no significant difference in complication rate between the groups (7% in group 1 vs 14% in group 2).ConclusionsPercutaneous fixation of acute undisplaced scaphoid fractures has union rates comparable with those of nonsurgical cast immobilization but with faster RTW and time to union without a significant difference in complication rate.Type Of Study/Level Of EvidenceTherapeutic II.Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

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