Dear Sir, Two good quality randomized trials in the 1990s looked at conservative management of scaphoid fractures, and clarified the type of cast required to treat these fractures. Clay et al. (1991) demonstrated clearly in a prospective randomized trial of 292 fresh scaphoid fractures that a below-elbow cast excluding the thumb was adequate for treatment of fresh undisplaced fractures. They found no benefit from immobilizing the thumb in a scaphoid-type cast in terms of union rate or functional outcome. The scaphoid cast is more inconvenient for patients, as shown in a further study by Karantana et al. (2006) who looked at functional impairment in scaphoid and thumb-free casts. Hambidge et al. (1999) showed, in a randomized trial of 121 scaphoid fractures, that below-elbow casting in slight extension, compared with slight flexion, is better for regaining full wrist extension after cast removal, whilst having no effect on fracture union.
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