Determining scaphoid waist fracture union by conventional radiographic examination: an analysis of reliability and validity

Hannemann, P. F. W.; Brouwers, Lars; Dullaert, K.; Linden, E.S. van der; Poeze, Martijn; Brink, Peter R.

doi:10.1007/s00402-014-2147-9

Cited by 30 publications

(16 citation statements)

References 24 publications

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“…Therefore, CT scanning is probably the most reliable method of assessing scaphoid union as it can demonstrate trabecular healing crossing the fracture site. 72 This systematic review and meta-analysis show that MRI has the highest sensitivity and specificity for detecting scaphoid fractures. CT and US were shown to be significantly lower.…”

Section: Discussionmentioning

confidence: 86%

Systematic Review of Diagnosis of Clinically Suspected Scaphoid Fractures

Bäcker

Strauch

2019

Jnl Wrist Surg

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Background Scaphoid fracture accounts for approximately 15% of acute wrist fractures. Clinical examination and plain X-rays are commonly used to diagnose the fracture, but this approach may miss up to 16% of fractures in the absence of clear-cut lucent lines on plain radiographs. As such, additional imaging may be required. It is not clear which imaging modality is the best. The goal of this study is to summarize the current literature on scaphoid fractures to evaluate the sensitivity, specificity, and accuracy of four different imaging modalities. Case Description A systematic-review and meta-analysis was performed. The search term “scaphoid fracture” was used and all prospective articles investigating magnetic resonance imaging (MRI), computed tomography (CT), bone scintigraphy, and ultrasound were included. In total, 2,808 abstracts were reviewed. Of these, 42 articles investigating 51 different diagnostic tools in 2,507 patients were included. Literature Review The mean age was 34.1 ± 5.7 years, and the overall incidence of scaphoid fractures missed on X-ray and diagnosed on advanced imaging was 21.8%. MRI had the highest sensitivity and specificity for diagnosing scaphoid fractures, which were 94.2 and 97.7%, respectively, followed by CT scan with a sensitivity and specificity at 81.5 and 96.0%, respectively. The sensitivity and specificity of ultrasound were 81.5 and 77.4%, respectively. Significant differences between MRI, bone scintigraphy, CT, and ultrasound were identified. Clinical Relevance MRI has higher sensitivity and specificity than CT scan, bone scintigraphy, or ultrasound. Level of Evidence This is a Level II systematic review.

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Section: Discussionmentioning

confidence: 86%

Systematic Review of Diagnosis of Clinically Suspected Scaphoid Fractures

Bäcker

Strauch

2019

Jnl Wrist Surg

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“…In the early post-trauma period, Dias et al demonstrated that XR cannot be used to identify scaphoid consolidation due to the difficulty of identifying the trabecular crossing of the fracture and sclerosis of the fracture line in the context of the shape and orientation of the scaphoid bone [ 25 , 26 ]. Hannemann suggested that XR at six weeks after injury can be reliably used so as to determine whether scaphoid waist fractures (corresponding to Schernberg’s zones II, III, and IV) have actually healed (k = 0.816 for non-union) [ 27 ]. However, when documenting the union (partially or complete) based on conventional radiographic imaging displays less inter-observer agreement (k = 0.390).…”

Section: Discussionmentioning

confidence: 99%

Determining diagnosis of scaphoid healing: Comparison of cone beam CT and X-ray after six weeks of immobilization

Farracho

Moutinot²,

Neroladaki

et al. 2020

European Journal of Radiology Open

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Highlights Scaphoid union is controversial regarding diagnosis of healing. XR is the most used modality with poor reliability and reproducibility. CBCT allows with higher confidence diagnosis of consolidation avoiding longer immobilisation. Evaluation for translation is better with CBCT than XR at un early follow up. Six weeks is a reasonable delay to perform the first imaging follows up in waist scaphoid fracture.

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“…Although Computed Tomography (CT) scans and Magnetic Resonance Imaging (MRI) may provide better evidence of union 33 , 34 , it is not routinely used in our clinical setting. Plain wrist radiographs have been found to be adequate and reliable in diagnosing union postoperatively 31 , 35 , 36 . In addition, our results apply only to open scaphoid fixations with bone grafts and may not necessarily be valid for cases that were performed without bone grafts or performed through minimally invasive techniques.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Intra-carpal Kirschner Wire Augmentation in Screw Fixation of Scaphoid – A Retrospective Cohort Study

2020

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Determining scaphoid waist fracture union by conventional radiographic examination: an analysis of reliability and validity

Abstract: Conventional radiographic imaging is accurate and moderately reliable in diagnosing union, and reliable but inaccurate in diagnosing nonunion of scaphoid waist fractures at 6 weeks follow-up.

Cited by 30 publications

References 24 publications

Systematic Review of Diagnosis of Clinically Suspected Scaphoid Fractures

Systematic Review of Diagnosis of Clinically Suspected Scaphoid Fractures

Determining diagnosis of scaphoid healing: Comparison of cone beam CT and X-ray after six weeks of immobilization

The Effect of Intra-carpal Kirschner Wire Augmentation in Screw Fixation of Scaphoid – A Retrospective Cohort Study

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