Return to sport following scaphoid fractures: A systematic review and meta-analysis

Table 1 Inclusion and exclusion criteria

Inclusion criteria	Exclusion criteria
Acute scaphoid fractures	Scaphoid Fracture Delayed Union or Non-Union
Elite or recreational athletes	No sporting outcome data reported
Return rates to sporting activity reported	Paediatric fractures (age under 15)
Time to return to sporting activity reported	Concomitant upper or lower limb fractures
Two or more fractures reported	Reviews, case reports, abstracts or anecdotal articles
Peer-reviewed journals	Animal, cadaver or in vitro studies
English language

Table 2 Characteristics of the included studies

Ref.	Study location	n	Fracture type/ location	Gender (count)	Mean age	Study design	Treatment	Sport activity	Level of sport
Adolfsson et al[10] (2001)	Linkoping & Lund, Sweden	5	Waist (5)	N/A	31 (15-75)	RCT	PSF (3); Conservative (2)	Soccer (3); Swimming (1); Squash (1)	National level
Bedi et al[25] (2007)	Ann Arbor, Michigan, United States	6	B2 (6)	N/A	25 (16-62)	RCS	ORIF (6)	Sport (6)	Collegiate/ Professional
Ellsasser and Stein[27] (1979)	St. Louis, Missouri, United States	2	-	M: 2	N/A	CS	Conservative (2); Returned immediately	American football (2)	Professional
Huene[28] (1979)	Fresno, California, United States	4	-	N/A	N/A	CS	ORIF (4)	Sport (4)	N/A
McQueen et al[9] (2008)	Edinburgh, United Kingdom	55	B1 (1); B2 (54)	M: 50 F: 10	29.4 (17-65)	RCT	PSF (28); Conservative (27)	N/A	N/A
Muramatsu et al[24] (2002)	Yamaguchi, Japan	10	A2 (3); B2 (6); B3 (1)	M: 10	17.3 (13-22)	RCS	ORIF (10)	Badminton (1); Baseball (2); Basketball (2); Boxing (2); Handball (1); Judo (2); Rugby (1); Soccer (16); Tennis (1); Track (2)	N/A
Rettig et al[22] (1994)	Indianapolis, Indiana, United States	30	MT (30)	M: 25 F: 5	18.3	RCS	ORIF (18); Conservative (12); Returned immediately	Sport (30)	N/A
Rettig and Kollias[23] (1996)	Indianapolis, Indiana, United States	12	MT (10) PT (2)	M: 11 F: 1	21 (17-31)	RCS	ORIF (12)	Baseball (2); Basketball (8); Archery (2)	N/A
Riester et al[21] (1985)	Syracuse, New York, United States	14	MT (11) PT (3)	M: 13 F: 1	N/A	RCS	Conservative (14); Returned immediately	American Football (12); Basketball (1); Soccer (1)	Intercollegiate/ High school
Robertson et al[26] (2012)	Edinburgh, United Kingdom	20	MT (11); PT (4); DT (5)	M: 20	26.1	RCS	PSF (2); Conservative (18)	Soccer (20)	N/A
Robertson et al[29] (2014)	Edinburgh, United Kingdom	2	MT (1); DT (1)	M: 2	21	CS	Conservative (2)	Rugby (2)	N/A

RCT: Randomised controlled trial; RCS: Retrospective cohort study; CS: Case series; ORIF: Open reduction and internal fixation; PSF: Percutaneous surgical fixation; M: Male; F: Female; N/A: No data available; MT: Middle third; PT: Proximal third; DT: Distal third; A2: Stable waist fracture; B1: Unstable distal oblique fracture; B2: Unstable waist fracture; B3: Unstable proximal pole fracture; S: Surgical management; C: Conservative management.

Table 3 Scaphoid fractures - only fractures with follow-up data included (mean values unless otherwise stated).

Ref.	n	Mean follow-up	Coleman score	Return Rate	Return rate by treatment modality	Return rate to same level of sport	Return time (range)	Return time (range) by treatment modality	Rate of union	Time to union (range)	Complications by treatment modality
Adolfsson et al[10] (2001)	5	-	70	5/5	C: 2/2; S: 3/3	C: 2/2; S: 3/3	8.2 (6-12) wk	C: 11.5 (11-12) wk; S: 6 wk	C: 2/2; S: 3/3	C: N/A; S: N/A	C: Persistent radial border wrist pain (1); S: Nil
Bedi et al[25] (2007)	6	98 (12-272) wk	64	5/6	S: 5/6	S: 5/6	N/A	S: N/A	S: N/A	S: N/A	S: Non-union (6%) ; Scar sensitivity (6%)
Ellsasser & Stein[27] (1979)	2	-	42	2/2	C: 2/2	C: 2/2	0 wk	C: 0 wk	S: N/A	S: N/A	C: Nil
Huene[28] (1979)	4	-	48	4/4	S: 4/4	S: 4/4	7 (6-8) wk	S: 7 (6-8) wk	S: N/A	S: N/A	S: SRNN (40%)
McQueen et al[9] (2008)	55	1 yr	82	53/55	C: 26/27; S: 27/28	C: 26/27; S: 27/28	10.9 (2-26) wk	C: 15.5 (6-26) wk; S: 6.4 (2-20) wk	C: 23/27; S: 27/28	C: 13.9 (8-36) wk; S: 9.2 (8-18) wk	C: Non-union (4); Malunion (3); AVN (2); CRPS (1); Radioscaphoid OA(1); S: Peri-operative breakage of the cannulated screwdriver (2) Symptomatic metalwork (1); Non-union (1)
Muramatsu et al[24] (2002)	10	-	66	10/10	S: 10/10	n/a	10.7 (6-13) wk	S: 10.7 (6-13) wk	S: 10/10	S: 9.2 (6–16) wk	S: nil
Rettig et al[22] (1994)	30	C: 48.7 (9-136) wk; S: 49.3 (5-164) wk	63	29/30 (96.7%)	C: 11/12; S: 18/18	n/a	6.6 (0-21) wk	C: 4.3 (0-10) wk; S: 8 (3-21) wk	C: 11/12; S: 18/18	C: 14.2 (8-26) wk; S: 11.2 (4-24) wk	C: Non-union (1); S: nil
Rettig & Kollias[23] (1996)	12	2.9 yr	66	12/12 (100%)	S: 12/12	S: 12/12	5.8 (1-10) wk	S: 5.8 (1-10) wk	S: 11/12	S: 9.8 (6-18) wk	S: Non-union (1)
Riester et al[21] (1985)	14	47 mo (3.9 yr)	65	12/14	C: 12/14 (85.7%)	C: 12/14	0 wk	C: 0 (0-0) wk	C: 11/14	C: N/A	C: Non-union (3) (of which 2 patients required surgical intervention)
Robertson et al[26] (2012)	20	30 (24-36) mo	44	16/20	C: 14/181; S: 2/2	C: 13/181; S: 2/2	12.2 (6-24) wk	C: 12.7 (6-24) wk; S: 8.5 (8-9) wk	C: N/A; S: N/A	C: N/A; S: N/A	C: Non-union (3) (all 3 patient required delayed conversion to surgical fixation); S: Nil
Robertson et al[29] (2014)	2	40 (34-46) mo	44	2/2	C: 2/2	C 2/2	4 (4-4) wk	C: 4 (4-4) wk	C: N/A	C: N/A	C: Nil

¹Three fractures initially treated conservatively developed non-union and required conversion to surgical treatment. 2 of these returned to soccer post-surgery. N/A: No data available; S: Surgical management; C: Conservative management; SRNN: Superficial radial nerve neuropraxia; AVN: Avascular necrosis; CRPS: Complex regional pain syndrome; OA: Osteoarthritis.

Table 4 Summary of the return rates to sport and return times to sport by treatment modality

Mode of treatment	n	Return rates to sport	Mean return times to sport	Return rate to pre-injury level of sport	Union rate	Mean time to union
All[9,10,21-29]	160	150/160 (94%)[9,10,21-29]	8.4 wk[9,10,21-24,26-29]	110/120 (92%)[9,10,21,23,25-29]	116/126 (92%)[9,10,21-24]	11.3 wk[9,22-24]
Conservative[9,10,21,22,26,27,29]	77	69/77 (90%)[9,10,21,22,26,27,29]	9.6 wk[9,10,21,22,26,27,29]	57/65 (88%)[9,10,26,29]	47/55 (85%)[9,10,21,22]	14.0 wk[9,22]
Conservative - return in cast[21,22,27]	28	25/28 (89%)[21,22,27]	1.9 wk[21,22,27]	14/16 (88%)[21,27]	22/26 (85%)[21,22]	14.2 wk[22]
Conservative - return after cast[9,10,26,29]	49	44/49 (90%)[9,10,26,29]	13.9 wk[9,10,26,29]	43/49 (88%)[9,10,26,29]	25/29 (86%)[9,10]	13.9 wk[9]
Surgical[9,10,22-26,28]	83	81/83 (98%)[9,10,22-26,28]	7.3 wk[9,10,22-24,26,28]	53/55 (96%)[9,10,23,25,26,28]	69/71 (97%)[9,10,22-24]	9.8 wk[9,22-24]
ORIF[22-25,28]	50	49/50 (98%)[22-25,28]	7.9 wk[22-24,28]	21/22 (95%)[23,25,28]	39/40 (98%)[22-24]	10.3 wk[22-24]
PSF[9,10,26]	33	32/33 (97%)[9,10,26]	6.5 wk[9,10,26]	32/33 (97%)[9,10,26]	30/31 (97%)[9,10]	9.2 wk[9]