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10.08.20

Clinical trial demonstrates plaster cast effectiveness in young people

An NIHR-funded research study has demonstrated plaster casts to be just as effective at healing a common wrist fracture in young, active people as surgery, potentially reducing the number of young people requiring surgical procedures in the future.

Researchers found a plaster cast to provide as good healing as surgery for a fracture of the scaphoid bone (one of eight small bones in the wrist), a common type of wrist fracture in young, active people often caused by a fall on the hand or the hand being forced back suddenly.

The results of the SWIFFT trial, which was led by researchers at University Hospitals of Leicester NHS Trust, have been published in the peer-reviewed journal, the Lancet.

The trial suggested by opting for a plaster cast, patients can avoid the risk of surgery, while hospitals are able to maintain simple and cost effective service delivery, without compromising patient outcomes.

From 2013 to 2016, a total of 439 patients with a scaphoid waist fracture of the wrist were enrolled from 31 NHS hospitals across the UK. Patients who agreed to take part were randomly assigned into two arms of the trial: either to have surgery to hold the broken scaphoid with a special screw, or to have the wrist held still in a plaster cast (with surgery offered after six weeks to those that were still not healed).

After one year from the initial injury, patients were measured on a number of factors, including wrist pain and function, bone healing, complications from treatment, and average days of work lost.

As well as measuring pain scores, complications and average days of work lost, the researchers also factored in the health economics of surgery versus plaster cast. Over the year, the cost of surgery to the NHS was significantly higher at £2,350 per patient, compared to the cost of plaster cast treatment at just an average of £727 per patient.

Professor Joseph Dias, orthopaedic surgeon at the University Hospitals of Leicester NHS Trust and Chief Investigator for the SWIFFT trial, said: “This study confirms that putting a wrist with a broken scaphoid in a plaster cast provides as good healing as surgery, so long as the few that do not re-join are identified and fixed by the medical team. Fixing the scaphoid by surgery does not speed up healing and the time taken to return to work is the same as when a cast is used.

“With our research, patients and medical practitioners can be confident that we can treat patients with this fracture safely and effectively in a cast, resorting to surgery only when the bone doesn’t heal”.

The study was funded by the NIHR Health Technology Assessment Programme.

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