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

Abstract

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.

Time‐dependent changes in bone healing capacity of scaphoid fractures and non‐unions

“…; Bervian et al. ). However, histology in these publications is based primarily on overview staining.…”

“…Bervian et al. () subdivided the SNU into four groups according to the vascularity, presence and appearance of osteoblasts, and the loss of trabecular regularity. In addition to these parameters, we assessed cell density, osteoid formation, the presence of trabecular spikes, cartilage formation and intertrabecular cells in order to assign a healing status of high activity, partial activity or little activity to the tissue.…”

“…; Bervian et al. ). Parameters were defined and grouped according to three activity levels (high, partial and little) as described in Table and were evaluated for their presence.…”

“…In most studies, histology consists only of simple overview staining such as Haematoxylin & Eosin (HE) (Bervian et al. ). However, this does not sufficiently characterise the tissue under investigation.…”

“…The knowledge of bone structure and biology around the SNU therefore seems to be of great importance. In most studies, histology consists only of simple overview staining such as Haematoxylin & Eosin (HE) (Bervian et al 2015). However, this does not sufficiently characterise the tissue under investigation.…”