Patient expectations and outcomes of successful scaphoid surgery: a prospective cohort analysis using the trauma expectation and trauma outcome measure (TEFTOM).

backgroundScaphoid fractures are common carpal injuries that are commonly treated operatively. Increasingly, patient-reported outcome measures (PROMs) highlight the influence of expectations on perceived success. The Trauma Expectation and Trauma Outcome Measure (TEFTOM) is a validated instrument assessing expectations (TEF) and outcomes (TOM) across domains of pain, function, disability, injury satisfaction, and overall satisfaction. While applied in other orthopaedic trauma conditions, TEFTOM has not been previously studied in scaphoid surgery.

methodsThis prospective cohort study enrolled 51 adult patients with acute scaphoid fractures treated operatively and achieving union within 6 months. The TEF questionnaire was administered preoperatively, while the TOM was administered at 12 and 24 months. Expectation fulfillment was calculated as TOM/TEF (%). Clinical measures included the Mayo Wrist Score and Patient-Rated Wrist Evaluation (PRWE). Correlation analyses assessed relationships between expectations, outcomes, and satisfaction.

resultsThe median patient age was 31 years; 66.7% sustained right-sided injuries, and most fractures involved the scaphoid waist (72.5%). Baseline TEF scores were uniformly high (mean 37/40). TOM scores improved from 31.3 at 12 months to 35.2 at 24 months (P < 0.001). Fulfillment rose from 84.8% at 12 months to 95.4% at 24 months. Satisfaction strongly correlated with fulfillment at both 12 months (r = 0.78, p < 0.001) and 24 months (r = 0.65, p < 0.001), but not with Mayo Wrist or PRWE scores. Higher baseline expectations predicted lower fulfillment and lower satisfaction despite similar functional outcomes. Patients in the low-expectation tertile reported greater fulfillment and satisfaction compared with the high-expectation group (p < 0.001).

conclusionThis first application of the TEFTOM instrument in scaphoid fracture surgery demonstrates its ability to differentiate objective recovery from subjective fulfillment. Despite uniformly favorable functional outcomes, higher preoperative expectations were associated with lower fulfillment and satisfaction. Continued improvement between 12 and 24 months highlights the prolonged recovery trajectory of scaphoid injuries. Integrating expectation assessment through TEFTOM may enhance patient counseling and provide a more comprehensive evaluation of surgical success beyond traditional PROMs. LEVEL OF EVIDENCE: Prospective cohort study, Level II.