Acute fractures of the scaphoid - Treatment by cast immobilisation with the wrist in flexion or extension?

Acute fractures of the scaphoid were randomly allocated for conservative tr eatment in a Colles'-type plaster cast with the wrist immobilised in either 20 degrees flexion or 20 degrees extension. The position of the wrist did not influence the rate of union of the fracture (89%) but when reviewed aft er six months the wrists which had been immobilised in flexion had a greate r restriction of extension. We recommend that acute fractures of the scapho id should be treated in a Colles'-type cast with the wrist in slight extens ion.