Imaging and Treatment of Scaphoid Fractures and Their Complications

Taljanovic, Mihra S.; Karantanas, Apostolos H.; Griffith, James F.; DeSilva, Gregory L.; Rieke, Joshua D.; Sheppard, Joseph E.

doi:10.1055/s-0032-1311767

Cited by 23 publications

(11 citation statements)

References 69 publications

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“…Any fracture that persists for longer than six months is considered a nonunion [3]. Non-union can show a distinct pattern of degenerative changes, eventually leading to a scaphoid non-union advanced collapse wrist [4]. In established non-union, the treatment goal, in addition to bone union with restoration of the shape of the scaphoid, should be to re-establish wrist function so that the patient can resume normal activities [5].…”

Section: Introductionmentioning

confidence: 99%

Scaphoid fracture nonunion: correlation of radiographic imaging, proximal fragment histologic viability evaluation, and estimation of viability at surgery

Bervian

Ribak

Livani

2014

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to correlate the preoperative imaging, vascularity of the proximal pole, and histology of the proximal pole bone of established scaphoid fracture non-union. Methods This was a prospective non-controlled experimental study. Patients were evaluated pre-operatively for necrosis of the proximal scaphoid fragment by radiography, computed tomography (CT) and magnetic resonance imaging (MRI). Vascular status of the proximal scaphoid was determined intra-operatively, demonstrating the presence or absence of puncate bone bleeding. Samples were harvested from the proximal scaphoid fragment and sent for pathological examination. We determined the association between the imaging and intra-operative examination and histological findings. Results We evaluated 19 male patients diagnosed with scaphoid nonunion. CT evaluation showed no correlation to scaphoid proximal fragment necrosis. MRI showed marked low signal intensity on T1-weighted images that confirmed the histological diagnosis of necrosis in the proximal scaphoid fragment in all patients. Intra-operative assessment showed that 90 % of bones had absence of intra-operative puncate bone bleeding, which was confirmed necrosis by microscopic examination. Conclusions In scaphoid nonunion MRI images with marked low signal intensity on T1-weighted images and the absence of intra-operative puncate bone bleeding are strong indicatives of osteonecrosis of the proximal fragment.

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Section: Introductionmentioning

confidence: 99%

Scaphoid fracture nonunion: correlation of radiographic imaging, proximal fragment histologic viability evaluation, and estimation of viability at surgery

Bervian

Ribak

Livani

2014

International Orthopaedics (SICOT)

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“…According to Taljanovic et al 29 CT allows better visualisation of fracture line, displacement and angulation of fracture fragments, and MRI without contrast is the investigation of choice for diagnosing occult scaphoid fractures. Bretlau 4 in his study concluded that scaphoid fractures can be diagnosed earlier, using dedicated-extremity MRI.…”

Section: Discussionmentioning

confidence: 99%

Early scaphoid fractures are better diagnosed with ultrasonography than X-rays: A prospective study over 114 patients

Jain¹,

Jain

Sheikh³

et al. 2018

Chinese Journal of Traumatology

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PurposeWrist has a complex anatomy and undergoes complex injuries. Scaphoid fracture is one of such injuries. It is the most common fracture in carpal bone. Most of the scaphoid fractures are missed on initial X-rays. Magnetic resonance imaging (MRI) is considered as a gold standard for diagnosing scaphoid fractures. Ultrasonography (USG) is emerging as a good alternative to make an early diagnosis of scaphoid fractures. Our aim is to throw light upon the role of USG in detection of scaphoid fractures.MethodsThe study was centered upon 114 patients in the age range 10–65 years, with traumatic wrist injury and were clinically suspected to have scaphoid fractures. Patient with non-traumatic history, bilateral wrist injury and late presentation were excluded. X-rays, USG using high frequency probe and MRI were done for all patients. MRI was considered to be the gold standard test. Patients were followed up at 6 weeks.ResultsOf the 114 patients, X-ray could diagnose scaphoid fractures in 48 patients, 30 of which were confirmed by MRI. USG results were positive in 74 patients, of which MRI was positive in 67 patients. The accuracy of scaphoid fracture detection with USG was 98.04% in comparison to X-ray (20.58%), which was statistically significant.ConclusionUSG provides a more accurate and reliable method of making an early diagnosis of scaphoid fracture than X-rays. It is non-invasive, non-expensive and allows better visualisation of cortical disruption.

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“…Der Frakturverlauf im Verhältnis zur Längsachse wurde von Russe als Instabilitätskriterium herangezogen [5]. Horizontal-oder querverlaufende Frakturen haben eine bessere Heilungsprognose als vertikale Frakturen [3,17].…”

Section: Frakturverlaufunclassified

“…Frakturen des Kahnbeins sind mit etwa 70-80 % die häufigsten Frakturen der Handwurzel [1]. Sowohl die komplexe Form des Kahnbeins als auch die retrograde Blutversorgung erschweren die Heilung, wodurch es häufig zu Pseudarthrosen und letztlich zum karpalen Kollaps kommt [2,3].…”

Section: Introductionunclassified