Return to sport following scaphoid fractures:A systematic review and meta-analysis
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摘要
BACKGROUND Scaphoid fracture is the most commonly fractured carpal bone in the athletic patient, accounting for over 85% of all sport-related carpal bone fractures, and is 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.AIM To review systemically all studies recording return to sport following scaphoid fractures, to collate information on return rates to sport(RRS) and mean return times(RTS) to sport and to determine differences in sporting outcome for the various treatment methods.METHODS A systematic search of MEDLINE, EMBASE, CINAHAL, Cochrane, Google Scholar, Physiotherapy Evidence Database, SPORTDiscus, Web of Science and Scopus was performed in August 2018 using the keywords "scaphoid","fracture", "acute", "carpal", "athletes", "sports", "non-operative","conservative", "operative" and "return to sport". All studies that recorded RRS and RTS following scaphoid fractures were included. RTS was recorded as the length of time from commencement of either primary conservative management or primary surgical procedure to return to sport.RESULTS Eleven studies were included: Two randomised controlled trials, six retrospective cohort studies and three case series. Seven studies reported on conservative management(n = 77), and eight studies reported on surgical management(n =83). For conservative management, RRS was 90%(69/77), and the mean RTS was9.6 wk. Three studies allowed to return to sport in cast [RRS 89%(25/28); RTS 1.9 wk], and four studies required completion of cast treatment prior to returning to sport [RRS 90%(44/49); RTS 13.9 wk]. Four studies recorded fracture union data:Union rate 85%(47/55); mean time to union 14.0 wk. For surgical management,RRS was 98%(81/83), and RTS was 7.3 wk. Three studies reported on Percutaneous Screw Fixation [RRS 97%(32/33); RTS 6.5 wk], and five studies reported on Open Reduction Internal Fixation [RRS 98%(49/50); RTS 7.9 wk]. Six studies recorded fracture union data: Union rate 97%(69/71); mean time to union9.8 wk. On meta-analysis, RRS(RR = 1.09; 95% confidence interval(CI): 1.00-1.18;P < 0.045), RTS(MD 2.3 wk; 95%CI: 0.79-3.87; P < 0.002), union rates(RR = 1.14;95%CI: 1.01-1.28; P < 0.030) and mean times to union(MD 4.2 wk; 95%CI: 3.94-4.36; P < 0.001) were all significantly better for the surgical cohort compared to the conservative cohort.CONCLUSION Surgical management of scaphoid fractures can provide significantly improved RRS and RTS to sport compared to conservative management. Both treatments,however, remain acceptable options, and athletes should be fully informed of the benefits and risks of both prior to deciding treatment plans. Immediate return to sport in a cast should be avoided due to the significant risk of non-union.
BACKGROUND Scaphoid fracture is the most commonly fractured carpal bone in the athletic patient, accounting for over 85% of all sport-related carpal bone fractures, and is 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.AIM To review systemically all studies recording return to sport following scaphoid fractures, to collate information on return rates to sport(RRS) and mean return times(RTS) to sport and to determine differences in sporting outcome for the various treatment methods.METHODS A systematic search of MEDLINE, EMBASE, CINAHAL, Cochrane, Google Scholar, Physiotherapy Evidence Database, SPORTDiscus, Web of Science and Scopus was performed in August 2018 using the keywords "scaphoid","fracture", "acute", "carpal", "athletes", "sports", "non-operative","conservative", "operative" and "return to sport". All studies that recorded RRS and RTS following scaphoid fractures were included. RTS was recorded as the length of time from commencement of either primary conservative management or primary surgical procedure to return to sport.RESULTS Eleven studies were included: Two randomised controlled trials, six retrospective cohort studies and three case series. Seven studies reported on conservative management(n = 77), and eight studies reported on surgical management(n =83). For conservative management, RRS was 90%(69/77), and the mean RTS was9.6 wk. Three studies allowed to return to sport in cast [RRS 89%(25/28); RTS 1.9 wk], and four studies required completion of cast treatment prior to returning to sport [RRS 90%(44/49); RTS 13.9 wk]. Four studies recorded fracture union data:Union rate 85%(47/55); mean time to union 14.0 wk. For surgical management,RRS was 98%(81/83), and RTS was 7.3 wk. Three studies reported on Percutaneous Screw Fixation [RRS 97%(32/33); RTS 6.5 wk], and five studies reported on Open Reduction Internal Fixation [RRS 98%(49/50); RTS 7.9 wk]. Six studies recorded fracture union data: Union rate 97%(69/71); mean time to union9.8 wk. On meta-analysis, RRS(RR = 1.09; 95% confidence interval(CI): 1.00-1.18;P < 0.045), RTS(MD 2.3 wk; 95%CI: 0.79-3.87; P < 0.002), union rates(RR = 1.14;95%CI: 1.01-1.28; P < 0.030) and mean times to union(MD 4.2 wk; 95%CI: 3.94-4.36; P < 0.001) were all significantly better for the surgical cohort compared to the conservative cohort.CONCLUSION Surgical management of scaphoid fractures can provide significantly improved RRS and RTS to sport compared to conservative management. Both treatments,however, remain acceptable options, and athletes should be fully informed of the benefits and risks of both prior to deciding treatment plans. Immediate return to sport in a cast should be avoided due to the significant risk of non-union.
BACKGROUND Scaphoid fracture is the most commonly fractured carpal bone in the athletic patient, accounting for over 85% of all sport-related carpal bone fractures, and is 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.AIM To review systemically all studies recording return to sport following scaphoid fractures, to collate information on return rates to sport(RRS) and mean return times(RTS) to sport and to determine differences in sporting outcome for the various treatment methods.METHODS A systematic search of MEDLINE, EMBASE, CINAHAL, Cochrane, Google Scholar, Physiotherapy Evidence Database, SPORTDiscus, Web of Science and Scopus was performed in August 2018 using the keywords "scaphoid","fracture", "acute", "carpal", "athletes", "sports", "non-operative","conservative", "operative" and "return to sport". All studies that recorded RRS and RTS following scaphoid fractures were included. RTS was recorded as the length of time from commencement of either primary conservative management or primary surgical procedure to return to sport.RESULTS Eleven studies were included: Two randomised controlled trials, six retrospective cohort studies and three case series. Seven studies reported on conservative management(n = 77), and eight studies reported on surgical management(n =83). For conservative management, RRS was 90%(69/77), and the mean RTS was9.6 wk. Three studies allowed to return to sport in cast [RRS 89%(25/28); RTS 1.9 wk], and four studies required completion of cast treatment prior to returning to sport [RRS 90%(44/49); RTS 13.9 wk]. Four studies recorded fracture union data:Union rate 85%(47/55); mean time to union 14.0 wk. For surgical management,RRS was 98%(81/83), and RTS was 7.3 wk. Three studies reported on Percutaneous Screw Fixation [RRS 97%(32/33); RTS 6.5 wk], and five studies reported on Open Reduction Internal Fixation [RRS 98%(49/50); RTS 7.9 wk]. Six studies recorded fracture union data: Union rate 97%(69/71); mean time to union9.8 wk. On meta-analysis, RRS(RR = 1.09; 95% confidence interval(CI): 1.00-1.18;P < 0.045), RTS(MD 2.3 wk; 95%CI: 0.79-3.87; P < 0.002), union rates(RR = 1.14;95%CI: 1.01-1.28; P < 0.030) and mean times to union(MD 4.2 wk; 95%CI: 3.94-4.36; P < 0.001) were all significantly better for the surgical cohort compared to the conservative cohort.CONCLUSION Surgical management of scaphoid fractures can provide significantly improved RRS and RTS to sport compared to conservative management. Both treatments,however, remain acceptable options, and athletes should be fully informed of the benefits and risks of both prior to deciding treatment plans. Immediate return to sport in a cast should be avoided due to the significant risk of non-union.
引文
1 Aitken S,Court-Brown CM.The epidemiology of sports-related fractures of the hand.Injury 2008;39:1377-1383[PMID:18656191 DOI:10.1016/j.injury.2008.04.012]
2 Weber ER,Chao EY.An experimental approach to the mechanism of scaphoid waist fractures.J Hand Surg Am 1978;3:142-148[PMID:556476 DOI:10.1016/S0363-5023(78)80062-8]
3 Coutr-Brown C,McQueen M,Tornetta P.Trauma.1st ed.Philadelphia:Lippincott Williams Wilkins2006;
4 Parvizi J,Wayman J,Kelly P,Moran CG.Combining the clinical signs improves diagnosis of scaphoid fractures.A prospective study with follow-up.J Hand Surg Br 1998;23:324-327[PMID:9665518 DOI:10.1016/S0266-7681(98)80050-8]
5 Ring D,Lozano-Calderón S.Imaging for suspected scaphoid fracture.J Hand Surg Am 2008;33:954-957[PMID:18656772 DOI:10.1016/j.jhsa.2008.04.016]
6 Winston MJ,Weiland AJ.Scaphoid fractures in the athlete.Curr Rev Musculoskelet Med 2017;10:38-44[PMID:28251560 DOI:10.1007/s12178-017-9382-y]
7 Herbert TJ,Fisher WE.Management of the fractured scaphoid using a new bone screw.J Bone Joint Surg Br 1984;66:114-123[PMID:6693468 DOI:10.1097/00006534-198678060-00052]
8 Geoghegan JM,Woodruff MJ,Bhatia R,Dawson JS,Kerslake RW,Downing ND,Oni JA,Davis TR.Undisplaced scaphoid waist fractures:is 4 weeks'immobilisation in a below-elbow cast sufficient if a week 4 CT scan suggests fracture union?J Hand Surg Eur Vol 2009;34:631-637[PMID:19959447 DOI:10.1177/1753193409105189]
9 McQueen MM,Gelbke MK,Wakefield A,Will EM,Gaebler C.Percutaneous screw fixation versus conservative treatment for fractures of the waist of the scaphoid:a prospective randomised study.J Bone Joint Surg Br 2008;90:66-71[PMID:18160502 DOI:10.1302/0301-620X.90B1.19767]
10 Adolfsson L,Lindau T,Arner M.Acutrak screw fixation versus cast immobilisation for undisplaced scaphoid waist fractures.J Hand Surg Br 2001;26:192-195[PMID:11386765 DOI:10.1054/jhsb.2001.0558]
11 Dy CJ,Khmelnitskaya E,Hearns KA,Carlson MG.Opinions regarding the management of hand and wrist injuries in elite athletes.Orthopedics 2013;36:815-819[PMID:23746021 DOI:10.3928/01477447-20130523-30]
12 Rizzo M,Shin AY.Treatment of acute scaphoid fractures in the athlete.Curr Sports Med Rep 2006;5:242-248[PMID:16934205 DOI:10.1007/s11932-006-0005-4]
13 Moher D,Liberati A,Tetzlaff J,Altman DG;PRISMA Group.Preferred reporting items for systematic reviews and meta-analyses:the PRISMA statement.PLoS Med 2009;6:e1000097[PMID:19621072 DOI:10.1371/journal.pmed.1000097]
14 Coleman BD,Khan KM,Maffulli N,Cook JL,Wark JD.Studies of surgical outcome after patellar tendinopathy:clinical significance of methodological deficiencies and guidelines for future studies.Victorian Institute of Sport Tendon Study Group.Scand J Med Sci Sports 2000;10:2-11[PMID:10693606 DOI:10.1034/j.1600-0838.2000.010001002.x]
15 Del Buono A,Smith R,Coco M,Woolley L,Denaro V,Maffulli N.Return to sports after ankle fractures:a systematic review.Br Med Bull 2013;106:179-191[PMID:23258924 DOI:10.1093/bmb/lds039]
16 Robertson GA,Wood AM.Return to sports after stress fractures of the tibial diaphysis:a systematic review.Br Med Bull 2015;114:95-111[PMID:25712999 DOI:10.1093/bmb/ldv006]
17 Robertson GA,Wood AM.Return to Sport After Tibial Shaft Fractures:A Systematic Review.Sports Health 2016;8:324-330[PMID:27340245 DOI:10.1177/1941738115601425]
18 Robertson GA,Wood AM.Return to sport following clavicle fractures:a systematic review.Br Med Bull2016;119:111-128[PMID:27554280 DOI:10.1093/bmb/ldw029]
19 Robertson GAJ,Goffin JS,Wood AM.Return to sport following stress fractures of the great toe sesamoids:a systematic review.Br Med Bull 2017;122:135-149[PMID:28444129 DOI:10.1093/bmb/ldx010]
20 Robertson GAJ,Wong SJ,Wood AM.Return to sport following tibial plateau fractures:A systematic review.World J Orthop 2017;8:574-587[PMID:28808629 DOI:10.5312/wjo.v8.i7.574]
21 Riester JN,Baker BE,Mosher JF,Lowe D.A review of scaphoid fracture healing in competitive athletes.Am J Sports Med 1985;13:159-161[PMID:4014530 DOI:10.1177/036354658501300303]
22 Rettig AC,Weidenbener EJ,Gloyeske R.Alternative management of midthird scaphoid fractures in the athlete.Am J Sports Med 1994;22:711-714[PMID:7810798 DOI:10.1177/036354659402200522]
23 Rettig AC,Kollias SC.Internal fixation of acute stable scaphoid fractures in the athlete.Am J Sports Med1996;24:182-186[PMID:8775117 DOI:10.1177/036354659602400211]
24 Muramatsu K,Doi K,Kuwata N,Kawakami F,Ihara K,Kawai S.Scaphoid fracture in the young athlete--therapeutic outcome of internal fixation using the Herbert screw.Arch Orthop Trauma Surg 2002;122:510-513[PMID:12483331 DOI:10.1007/s00402-002-0417-4]
25 Bedi A,Jebson PJ,Hayden RJ,Jacobson JA,Martus JE.Internal fixation of acute,nondisplaced scaphoid waist fractures via a limited dorsal approach:an assessment of radiographic and functional outcomes.JHand Surg Am 2007;32:326-333[PMID:17336838 DOI:10.1016/j.jhsa.2007.01.002]
26 Robertson GA,Wood AM,Bakker-Dyos J,Aitken SA,Keenan AC,Court-Brown CM.The epidemiology,morbidity,and outcome of soccer-related fractures in a standard population.Am J Sports Med 2012;40:1851-1857[PMID:22610519 DOI:10.1177/0363546512448318]
27 Ellsasser JC,Stein AH.Management of hand injuries in a professional football team.Review of 15 years of experience with one team.Am J Sports Med 1979;7:178-182[PMID:464173 DOI:10.1177/036354657900700308]
28 Huene DR.Primary internal fixation of carpal navicular fractures in the athlete.Am J Sports Med 1979;7:175-177[PMID:464172 DOI:10.1177/036354657900700307]
29 Robertson GA,Wood AM,Heil K,Aitken SA,Court-Brown CM.The epidemiology,morbidity and outcome of fractures in rugby union from a standard population.Injury 2014;45:677-683[PMID:23830199 DOI:10.1016/j.injury.2013.06.006]
30 Modi CS,Nancoo T,Powers D,Ho K,Boer R,Turner SM.Operative versus nonoperative treatment of acute undisplaced and minimally displaced scaphoid waist fractures--a systematic review.Injury 2009;40:268-273[PMID:19195652 DOI:10.1016/j.injury.2008.07.030]
31 Belsky MR,Leibman MI,Ruchelsman DE.Scaphoid fracture in the elite athlete.Hand Clin 2012;28:269-278,vii[PMID:22883862 DOI:10.1016/j.hcl.2012.05.005]
32 Moatshe G,Godin JA,Chahla J,Cinque ME,Kennedy NI,Sanchez G,Beaulieu-Jones BR,LaPrade RF,Provencher MT.Clinical and Radiologic Outcomes After Scaphoid Fracture:Injury and Treatment Patterns in National Football League Combine Athletes Between 2009 and 2014.Arthroscopy 2017;33:2154-2158[PMID:29102567 DOI:10.1016/j.arthro.2017.08.259]Based Management.Elsevier 2018;99-106
33 de Boer BNP,Doornberg JN,Mallee WH,Buijze GA.Surgical Versus Conservative Treatment for Nondisplaced Scaphoid Waist Fractures.Buijze GA,Jupiter JB,editors.Scaphoid Fractures:Evidence-
2 Weber ER,Chao EY.An experimental approach to the mechanism of scaphoid waist fractures.J Hand Surg Am 1978;3:142-148[PMID:556476 DOI:10.1016/S0363-5023(78)80062-8]
3 Coutr-Brown C,McQueen M,Tornetta P.Trauma.1st ed.Philadelphia:Lippincott Williams Wilkins2006;
4 Parvizi J,Wayman J,Kelly P,Moran CG.Combining the clinical signs improves diagnosis of scaphoid fractures.A prospective study with follow-up.J Hand Surg Br 1998;23:324-327[PMID:9665518 DOI:10.1016/S0266-7681(98)80050-8]
5 Ring D,Lozano-Calderón S.Imaging for suspected scaphoid fracture.J Hand Surg Am 2008;33:954-957[PMID:18656772 DOI:10.1016/j.jhsa.2008.04.016]
6 Winston MJ,Weiland AJ.Scaphoid fractures in the athlete.Curr Rev Musculoskelet Med 2017;10:38-44[PMID:28251560 DOI:10.1007/s12178-017-9382-y]
7 Herbert TJ,Fisher WE.Management of the fractured scaphoid using a new bone screw.J Bone Joint Surg Br 1984;66:114-123[PMID:6693468 DOI:10.1097/00006534-198678060-00052]
8 Geoghegan JM,Woodruff MJ,Bhatia R,Dawson JS,Kerslake RW,Downing ND,Oni JA,Davis TR.Undisplaced scaphoid waist fractures:is 4 weeks'immobilisation in a below-elbow cast sufficient if a week 4 CT scan suggests fracture union?J Hand Surg Eur Vol 2009;34:631-637[PMID:19959447 DOI:10.1177/1753193409105189]
9 McQueen MM,Gelbke MK,Wakefield A,Will EM,Gaebler C.Percutaneous screw fixation versus conservative treatment for fractures of the waist of the scaphoid:a prospective randomised study.J Bone Joint Surg Br 2008;90:66-71[PMID:18160502 DOI:10.1302/0301-620X.90B1.19767]
10 Adolfsson L,Lindau T,Arner M.Acutrak screw fixation versus cast immobilisation for undisplaced scaphoid waist fractures.J Hand Surg Br 2001;26:192-195[PMID:11386765 DOI:10.1054/jhsb.2001.0558]
11 Dy CJ,Khmelnitskaya E,Hearns KA,Carlson MG.Opinions regarding the management of hand and wrist injuries in elite athletes.Orthopedics 2013;36:815-819[PMID:23746021 DOI:10.3928/01477447-20130523-30]
12 Rizzo M,Shin AY.Treatment of acute scaphoid fractures in the athlete.Curr Sports Med Rep 2006;5:242-248[PMID:16934205 DOI:10.1007/s11932-006-0005-4]
13 Moher D,Liberati A,Tetzlaff J,Altman DG;PRISMA Group.Preferred reporting items for systematic reviews and meta-analyses:the PRISMA statement.PLoS Med 2009;6:e1000097[PMID:19621072 DOI:10.1371/journal.pmed.1000097]
14 Coleman BD,Khan KM,Maffulli N,Cook JL,Wark JD.Studies of surgical outcome after patellar tendinopathy:clinical significance of methodological deficiencies and guidelines for future studies.Victorian Institute of Sport Tendon Study Group.Scand J Med Sci Sports 2000;10:2-11[PMID:10693606 DOI:10.1034/j.1600-0838.2000.010001002.x]
15 Del Buono A,Smith R,Coco M,Woolley L,Denaro V,Maffulli N.Return to sports after ankle fractures:a systematic review.Br Med Bull 2013;106:179-191[PMID:23258924 DOI:10.1093/bmb/lds039]
16 Robertson GA,Wood AM.Return to sports after stress fractures of the tibial diaphysis:a systematic review.Br Med Bull 2015;114:95-111[PMID:25712999 DOI:10.1093/bmb/ldv006]
17 Robertson GA,Wood AM.Return to Sport After Tibial Shaft Fractures:A Systematic Review.Sports Health 2016;8:324-330[PMID:27340245 DOI:10.1177/1941738115601425]
18 Robertson GA,Wood AM.Return to sport following clavicle fractures:a systematic review.Br Med Bull2016;119:111-128[PMID:27554280 DOI:10.1093/bmb/ldw029]
19 Robertson GAJ,Goffin JS,Wood AM.Return to sport following stress fractures of the great toe sesamoids:a systematic review.Br Med Bull 2017;122:135-149[PMID:28444129 DOI:10.1093/bmb/ldx010]
20 Robertson GAJ,Wong SJ,Wood AM.Return to sport following tibial plateau fractures:A systematic review.World J Orthop 2017;8:574-587[PMID:28808629 DOI:10.5312/wjo.v8.i7.574]
21 Riester JN,Baker BE,Mosher JF,Lowe D.A review of scaphoid fracture healing in competitive athletes.Am J Sports Med 1985;13:159-161[PMID:4014530 DOI:10.1177/036354658501300303]
22 Rettig AC,Weidenbener EJ,Gloyeske R.Alternative management of midthird scaphoid fractures in the athlete.Am J Sports Med 1994;22:711-714[PMID:7810798 DOI:10.1177/036354659402200522]
23 Rettig AC,Kollias SC.Internal fixation of acute stable scaphoid fractures in the athlete.Am J Sports Med1996;24:182-186[PMID:8775117 DOI:10.1177/036354659602400211]
24 Muramatsu K,Doi K,Kuwata N,Kawakami F,Ihara K,Kawai S.Scaphoid fracture in the young athlete--therapeutic outcome of internal fixation using the Herbert screw.Arch Orthop Trauma Surg 2002;122:510-513[PMID:12483331 DOI:10.1007/s00402-002-0417-4]
25 Bedi A,Jebson PJ,Hayden RJ,Jacobson JA,Martus JE.Internal fixation of acute,nondisplaced scaphoid waist fractures via a limited dorsal approach:an assessment of radiographic and functional outcomes.JHand Surg Am 2007;32:326-333[PMID:17336838 DOI:10.1016/j.jhsa.2007.01.002]
26 Robertson GA,Wood AM,Bakker-Dyos J,Aitken SA,Keenan AC,Court-Brown CM.The epidemiology,morbidity,and outcome of soccer-related fractures in a standard population.Am J Sports Med 2012;40:1851-1857[PMID:22610519 DOI:10.1177/0363546512448318]
27 Ellsasser JC,Stein AH.Management of hand injuries in a professional football team.Review of 15 years of experience with one team.Am J Sports Med 1979;7:178-182[PMID:464173 DOI:10.1177/036354657900700308]
28 Huene DR.Primary internal fixation of carpal navicular fractures in the athlete.Am J Sports Med 1979;7:175-177[PMID:464172 DOI:10.1177/036354657900700307]
29 Robertson GA,Wood AM,Heil K,Aitken SA,Court-Brown CM.The epidemiology,morbidity and outcome of fractures in rugby union from a standard population.Injury 2014;45:677-683[PMID:23830199 DOI:10.1016/j.injury.2013.06.006]
30 Modi CS,Nancoo T,Powers D,Ho K,Boer R,Turner SM.Operative versus nonoperative treatment of acute undisplaced and minimally displaced scaphoid waist fractures--a systematic review.Injury 2009;40:268-273[PMID:19195652 DOI:10.1016/j.injury.2008.07.030]
31 Belsky MR,Leibman MI,Ruchelsman DE.Scaphoid fracture in the elite athlete.Hand Clin 2012;28:269-278,vii[PMID:22883862 DOI:10.1016/j.hcl.2012.05.005]
32 Moatshe G,Godin JA,Chahla J,Cinque ME,Kennedy NI,Sanchez G,Beaulieu-Jones BR,LaPrade RF,Provencher MT.Clinical and Radiologic Outcomes After Scaphoid Fracture:Injury and Treatment Patterns in National Football League Combine Athletes Between 2009 and 2014.Arthroscopy 2017;33:2154-2158[PMID:29102567 DOI:10.1016/j.arthro.2017.08.259]Based Management.Elsevier 2018;99-106
33 de Boer BNP,Doornberg JN,Mallee WH,Buijze GA.Surgical Versus Conservative Treatment for Nondisplaced Scaphoid Waist Fractures.Buijze GA,Jupiter JB,editors.Scaphoid Fractures:Evidence-