Thumb Spica Casts for Scaphoid Fractures

(Strength of Recommendation [SOR]: B, randomized controlled trials and cross-sectional studies.) Thumb spica casts are no better than casts that do not include the thumb in fracture healing rates or long-term improvement in range of motion, strength, or pain. C, cross-sectional studies.) Evidence Summary FRACTURE UNION A 2014 multicenter randomized controlled trial from the Netherlands compared below-elbow casting with and without inclusion of the thumb for the treatment of nondisplaced or minimally displaced fractures of the scaphoid waist (n = 55) and distal scaphoid (n = 7).1 Included patients (n = 62) were 18 years or older and presented less than four weeks after injury with a scaphoid fracture confirmed by magnetic resonance imaging or computed tomography (CT) with less than 1 mm of gapping or translation between fracture fragments and no other associated fracture or perilunate injury. SCAPHOID MOVEMENT A 2019 cross-sectional study measured anatomic and functional range of motion for Colles-type casts and splints compared with scaphoid-type casts and splints.3 Ten healthy volunteers (mean age = 28 years) with no previous wrist injury or disability had flexion, extension, radioulnar deviation, and circumduction measured to determine their baseline achievable range of motion as well as baseline functional testing, including opening a jar lid, pouring from a jar, drinking the last drops from a cup, and simulated dart throwing.