What is the preferred immobilization method, rigid splint or wrist splint, for a patient with a healed right nondisplaced transverse fracture of the right navicular (scaphoid) bone, now with full mobility, one month post-injury?

From the Guidelines

For a right nondisplaced transverse fracture of the navicular bone at one month post-injury with full mobility, a rigid splint is recommended over a wrist splint. The rigid splint provides better immobilization of the navicular bone, which is crucial for proper healing due to its location and high risk of complications if not properly immobilized. According to the American College of Foot and Ankle Surgeons, simple immobilization is appropriate when fracture fragments are small, nonarticular, or minimally displaced 1. While the patient has full mobility, the navicular bone typically requires several weeks for complete healing, so continued protection is important even at the one-month mark. The rigid splint should provide sufficient stability to allow for proper healing.

• Key considerations for the choice of immobilization include:
  • The type of fracture: nondisplaced transverse fracture
  • The location of the fracture: navicular bone
  • The time since the injury: one month
  • The patient's current mobility: full mobility
• The patient should wear the rigid splint until cleared by orthopedics, as the orthopedic consultation is essential to evaluate healing progress through imaging and determine when the patient can safely discontinue immobilization and begin rehabilitation exercises to restore strength and prevent stiffness.

From the Research

Navicular Bone Fracture Treatment

• The patient has a right nondisplaced transverse fracture of the right navicular bone, which is a type of injury that can be challenging to treat 2, 3, 4.
• The treatment options for navicular fractures include conservative treatment with immobilization and no weight-bearing, as well as surgical treatment with open reduction and internal fixation (ORIF) or other procedures 5, 2, 3, 4.
• For nondisplaced fractures, conservative treatment may be sufficient, but displaced fractures often require surgical intervention to achieve anatomical reduction and stability 2, 3, 4.
• The choice of treatment depends on the severity of the injury, the patient's overall health, and the presence of any complications, such as avascular necrosis or nonunion 2, 3, 4.

Rigid Splint vs Wrist Splint

• There is no direct evidence in the provided studies to support the use of a rigid splint or a wrist splint for a navicular bone fracture 5, 2, 3, 4, 6.
• However, immobilization is a crucial aspect of treating navicular fractures, and a rigid splint or a wrist splint may be used to provide support and stability to the affected area 5, 2, 3, 4.
• The decision to use a rigid splint or a wrist splint should be made on a case-by-case basis, taking into account the individual patient's needs and the severity of the injury 2, 3, 4.

Consultation with Orthopedics

• Given the complexity of navicular fractures, consultation with an orthopedic specialist is essential to determine the best course of treatment 5, 2, 3, 4.
• The orthopedic specialist can evaluate the patient's condition, discuss the treatment options, and develop a personalized plan to achieve optimal outcomes 2, 3, 4.