SUSPECT STUDY
Multicenter RCT: occult scaphoid fractures
Published

The Suspect study is a multicenter randomized controlled trial that evaluated whether bandaging could replace casting in adults with suspected scaphoid fractures and normal initial radiographs, in order to reduce overtreatment. Participants presenting at the emergency department were randomized to either 3-day bandaging or 2-week casting. 

A total of 180 patients were included, of whom only 16 were ultimately diagnosed with a scaphoid fracture and no cases of nonunion occurred. The primary outcome, functional performance measured by the Quick Disabilities of the Arm, Shoulder and Hand (QDASH) score at three months, showed that bandaging was noninferior to casting. No significant differences were observed between groups in pain scores or other patient-reported outcomes. 

Patients treated with bandaging demonstrated better wrist range of motion at two weeks and reported higher satisfaction with their treatment compared with those treated with casting. 

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Conclusion 

The Suspect study demonstrates that routine casting for suspected scaphoid fractures with normal initial radiographs can be safely avoided. Bandaging with early reassessment after two weeks is an effective alternative that maintains functional outcomes while reducing unnecessary immobilization. 

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