Imaging for Acute and Chronic Scaphoid Fractures

Diagnostic and Therapeutic Approach to Acute Scaphoid Fractures

“…The lateral view is good to detect tubercle and distal scaphoid injuries and to identify hump deformities by calculating the capitolunate, radiolunate, and scapholunate angles. 3,24 An adequate radiographic study can detect fractures in 85% to 90% of cases. However, the initial radiographs can be negative, especially if the fractures are not displaced; the incidence of false-negative radiographs is up to 25%.…”

“…17 According to some studies, the sensitivity of the CT to diagnose acute scaphoid fractures is similar to that of the MRI, but, as a disadvantage, it is contingent to technical factors. 24 The CT is most useful in the acute setting, when the fracture is radiographically visible, due to its high degree of resolution; in addition, its multiplanar capacity make it the ideal test for surgical planning. The choice between MRI or CT to diagnose occult fractures is largely based on local availability soon after injury.…”

“…As such, when other methods are not available, ultrasound cannot be considered as reliable as a second imaging test to detect occult scaphoid fractures. 24 A new technique using dual-energy computed tomography (DECT) has been developed, and shows promise in identifying acute scaphoid fractures (and other fractures). A version of this technique enables calcium subtraction, improving the visualization of bone marrow edema due to the increased image density.…”

“…Although its role in evaluating soft tissues and deeper bone structures is very limited, studies have documented that the sensitivity of the CBCT in diagnosing scaphoid fractures is higher compared to that of radiographs, and that, at the wrist, the CBCT is just as good as conventional CT for diagnostic purposes. 24 Its advantages include the lower cost, the fact that it can be easily positioned, and it is performed with the patient sitting down or standing up (instead of lying down with the arm in Superman position), and the lower exposure to ionizing radiation.…”

“…The most sensitive test for its correct assessment is CT, which also provides information on comminution and joint incongruity. 24 Therefore, a fracture detected on plain radiographs, especially if it is not displaced, must be confirmed with a CT scan. This test enables a more accurate evaluation of the displacement, a key factor in determining the conservative or surgical treatment of the fracture; in addition, it enables a good preoperative planning to define aspects such as the best approach, the appropriate osteosynthesis material etc.…”