Minimally displaced scaphoid waist fractures rarely show concurrent ligament injury or progression over five years.
This secondary analysis of the SWIFFT randomized controlled trial examined the incidence of concurrent ligament injuries and radiological changes over five years in patients with minimally displaced scaphoid waist fractures. The study included 439 patients with fractures displaced by ≤ 2 mm who were treated with either cast immobilization or surgical fixation. The primary outcomes were assessed at baseline, 52 weeks, and five years.
On initial imaging, scapholunate (SL) gap widening > 3 mm was observed in 12 patients (2.8%). No patient showed lunotriquetral (LT) gap widening. At the five-year follow-up, there was no progression of SL gap widening from the baseline findings. The analysis included 345 patients for the SL/LT interval assessment at five years.
Safety and tolerability data were not reported for this analysis. The study's findings are based on secondary analysis of RCT data and explore association rather than causation. Key limitations include that the analysis was limited to fractures displaced ≤ 2 mm, so findings may not apply to more displaced fractures. Additionally, ligament injuries not identified by standard imaging may exist but did not show progression over the study period.
For clinical practice, these results suggest that treatment of minimally displaced scaphoid waist fractures with cast or surgical fixation, without additional imaging or intervention for potential ligament injury, appears adequate for most patients. However, clinicians should recognize that this analysis does not address fractures with greater displacement.
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