Systematic Review
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Feb 18, 2019; 10(2): 101-114
Published online Feb 18, 2019. doi: 10.5312/wjo.v10.i2.101
Return to sport following scaphoid fractures: A systematic review and meta-analysis
Joaquim S Goffin, Quintin Liao, Gregory AJ Robertson
Joaquim S Goffin, Department of Orthopaedic and Trauma Surgery, Ninewells Hospital, Dundee DD2 1SY, United Kingdom
Quintin Liao, Department of Orthopaedic and Trauma Surgery, Forth Valley Royal Hospital, Larbert FK5 4WR, United Kingdom
Gregory AJ Robertson, Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Scotland EH16 4SA, United Kingdom
Author contributions: Goffin JS, Liao Q and Robertson GAJ conceived the methodology for the manuscript, performed the literature search and analysis for the study, and wrote the manuscript.
Conflict-of-interest statement: All authors have no conflicts of interest to report.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Greg AJ Robertson, BSc, MBChB, MSc, Surgeon, Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Scotland EH16 4SA, United Kingdom. greg_robertson@live.co.uk
Telephone: +44-131-2423545 Fax: +44-131-2423541
Received: September 12, 2018
Peer-review started: September 12, 2018
First decision: October 5, 2018
Revised: November 3, 2018
Accepted: January 10, 2019
Article in press: January 10, 2019
Published online: February 18, 2019
Processing time: 159 Days and 7.9 Hours
ARTICLE HIGHLIGHTS
Research background

Scaphoid fractures account for over 85% of all sport-related carpal bone fractures and are particularly common in sports involving high impact injuries to the wrist. The management of such injuries comprises both conservative and surgical techniques, as guided by fracture location and type. Athletes demonstrate a unique challenge with regards to the management of scaphoid fractures due to their requirement to return to sport as soon as able.

Research motivation

Scaphoid fractures significantly impact an athlete’s ability to return to sport. This topic should therefore be addressed to understand further the outcome of various treatment options and to optimise the management of these injuries.

Research objectives

To identify the available literature reporting on the sporting outcomes of both conservative and surgical management of scaphoid fractures in the athletic population.

Research methods

A systematic review of the available literature was performed, identifying all articles reporting on return rates to sport (RRS) and return times to sport (RTS) following acute scaphoid fractures. A total of 160 acute scaphoid fractures were included for analysis.

Research results

The RRS for conservative management and for surgical management were 90% and 98%, respectively. The mean RTS was lower in the surgical cohort at 7.3 wk, compared to 9.6 wk in the conservative cohort. Union rate was higher in the surgical cohort at 97% compared to 85% in the conservative cohort. On meta-analysis, surgical management of scaphoid fractures provided significantly better RRS, RTS, union rates and mean times to union as compared to conservative management.

Research conclusions

Most athletes can expect to return to sports following scaphoid fractures, with either conservative or surgical management. Surgical management did however offer improved RRS, RTS and union rates. Both treatment options remain appropriate in the management of scaphoid fractures, and patients should be counselled accordingly prior to treatment decisions. Return to sport in a cast should be discouraged due to the risk of non-union.

Research perspectives

The management of scaphoid fractures remains a challenge in the athletic population. Further well-designed studies should aim to address this topic in order to provide a better understanding of the RRS and RTS following the various treatment methods for acute scaphoid fractures in the athlete.