Current methods of diagnosis and treatment of scaphoid fractures

Abstract

Fractures of the scaphoid bone mainly occur in young adults and constitute 2-7% of all fractures. The specific blood supply in combination with the demanding functional requirements can easily lead to disturbed fracture healing. Displaced scaphoid fractures are seen on radiographs. The diagnostic strategy of suspected scaphoid fractures, however, is surrounded by controversy. Bone scintigraphy, magnetic resonance imaging and computed tomography have their shortcomings. Early treatment leads to a better outcome. Scaphoid fractures can be treated conservatively and operatively. Proximal scaphoid fractures and displaced scaphoid fractures have a worse outcome and might be better off with an open or closed reduction and internal fixation. The incidence of scaphoid non-unions has been reported to be between 5 and 15%. Non-unions are mostly treated operatively by restoring the anatomy to avoid degenerative wrist arthritis.

Open reduction and fixation of scaphoid fracture with bone grafting to avoid nonunion

“…Fractures of the scaphoid bone mainly occur in young adults and constitute 2-7% of all fractures [1].…”

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ARTICLE INFO ABSTRACTFractures of the scaphoid bone mainly occur in young adults and constitute 2-7% of all fractures [1].The specific blood supply in combination with the demanding functional requirements can easily lead to disturbed fracture healing, scaphoid fractures are more prone for AVN. Undisplaced scaphoid fractures are not seen on radiographs hence the diagnostic strategy of suspected scaphoid fractures is surrounded by controversy and may require bone scintigraphy, magnetic resonance imaging and computed tomography which have their shortcomings.

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Comparison of conventional radiography and MDCT in suspected scaphoid fractures

“…In addition to that, the common issue of radiation exposure from MDCT has been countered by the implementation of iterative reconstruction techniques which allow for a significant dose reduction of up to 75% without loss of anatomical information [6,7,33] . We have not included magnetic resonance imaging [11,15] or bone scintigraphy [8,16,17] into our study design. Both modalities represent complementary imaging approaches which can be used to assess mid-hand fractures with a sensitivity comparable to MDCT [11,[15][16][17] , but their availability within the emergency room setup is clearly limited.…”

“…Thirty-one percent of the institutions tend to perform a repeat radiograph at the first clinic review, within two weeks post-injury, although the limited value of this approach has been underlined before [11,15] . In contrast to the international treatment, the German society of trauma (DGU) supports early cross-sectional imaging [multidetector computed tomography (MDCT)] in their guidelines [8,16,17] . During the last decade, cross-sectional imaging has gained in prominence in the detection of scaphoid fractures.…”

Diagnostic imaging of suspected scaphoid fractures: A literature review

“…It preserves normal alignment of the carpal bones creating normal wrist motion and as such, complications may lead to significant long-term disability [1] . Scaphoid fractures commonly happen in youth and they represent about 4% of all fractures [2] (see Figure 1). …”