Review of imaging of scaphoid fractures

Abstract

Scaphoid fractures are the most common fractures of the carpus, accounting for 79% of all carpal fractures. Early diagnosis of scaphoid fractures is imperative owing to potential complications following the fracture, including non-union, avascular necrosis, carpal instability and osteoarthritis. Plain radiography remains the initial imaging modality to assess scaphoid fractures. Magnetic resonance imaging (MRI) is excellent in the detection of clinically suspected, but initially radiographically negative, scaphoid fractures. Cost-effectiveness analysis studies have demonstrated MRI is effective in this setting. Gadolinium enhanced MRI has been shown to be superior to unenhanced MRI in the detection of avascular necrosis. Computerized tomography scan is the preferred modality to assess the intricacies of scaphoid fracture, including fracture location and deformity, as well as union status. This review paper explores the recent advances in imaging of the scaphoid, with reference also to avascular necrosis and non-union following a scaphoid fracture.

Segmental fracture of the scaphoid

“…If a fracture is suspected, MRI is considered inferior to CT for the identification of fracture location, morphology, displacement and union status 8. Smith et al therefore recommend CT as standard after all initial positive radiographs 8.…”

“…Smith et al therefore recommend CT as standard after all initial positive radiographs 8. CT also has an 85.2% sensitivity and 99.5% specificity for the detection of acute scaphoid fracture 15.…”

Fractures of the Scaphoid, Capitate and Triquetrum in a Child: A Case Report

“…Nonetheless, in a study, an 11-yearold with multiple undisplaced carpal fractures was treated conservatively and achieved adequate fracture healing. 9 Further magnetic resonance imaging may aid diagnosis and reveal displacement of carpal fractures in children, [9][10][11] as radiographs fail to reveal fractures in 37% of children with hand or wrist injuries. 12 A high level of suspicion is therefore important in children with hand or wrist injuries.…”

A quantitative definition of scaphoid union: determining the inter-rater reliability of two techniques

“…Dias et al also reported that radiographs taken 12 weeks after a scaphoid fracture do not provide reliable and reproducible evidence of healing [1]. Many authors have reported that computerized tomography is the preferred method of assessing scaphoid fracture location, deformity, displacement, and union status [2,10-14], and it was also reported by Bain that computerized tomography (CT) scans have a higher correlation with operative findings [14]. …”