Nonsurgical Management

Wrist and thumb immobilization is the first step in acute treatment for non-displaced distal scaphoid fractures and is an option for treating some of the more complex scaphoid fractures. Scaphoid fractures that present more than 3 weeks after the injury may need more aggressive treatment, and orthopedic consultation is suggested. Waist fractures should be considered for open reduction; however, nondisplaced, horizontal oblique fractures of the waist have the best chance of successful nonsurgical treatment. Though closed treatment has less surgical risk, prolonged immobilization and nonunion are other risks to consider. Closed treatment consists of 6 weeks in a long-arm cast, followed by a short-arm cast worn until healing is seen on radiographs. Waist fractures require a total of 8 to 12 weeks of immobilization. Vertical oblique fractures of the waist should be referred to an orthopedist.

Closed treatment ofstable, nondisplaced fractures on the proximal pole can be attempted; however, orthopedic referral is suggested because open treatment is preferable. Proximal pole fractures require 12 to 24 weeks of immobilization for closed treatment.

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