Subacute scaphoid fractures. A closer look at closed treatment

Twenty-three subacute scaphoid fractures were retrospectively reviewed to determine the efficacy of nonoperative treatment. All of the patients sought medical attention between 4 weeks and 6 months after injury, and their fractures were classified according to location and stability. Nineteen fractures were observed to radiographic union or until closed treatment was abandoned; four patients were lost to followup. Nine of 10 stable subacute middle-third scaphoid fractures healed with cast immobilization in an average of 19 weeks (range, 11 to 38), and these were compared with a randomly selected group of acute middle-third fractures that healed in an average of 10 weeks (range, 6 to 13). Five of six unstable subacute middle-third fractures healed in an average of 20 weeks. One of these had a symptomatic humpback deformity treated by cheilectomy. Of three subacute proximal-third fractures, only one healed after 29 weeks of closed treatment. This study demonstrates that stable subacute middle-third scaphoid fractures will heal with cast treatment but may take twice as long to do so as stable acute middle-third fractures. Unstable subacute middle-third scaphoid fractures and subacute proximal-third fractures appear less likely to heal with closed treatment.