The role of MR imaging in scaphoid disorders

Abstract

The scaphoid bone of the wrist is one of the most commonly fractured bones in the body. Due to its importance in the biomechanics and functionality of the wrist, it is important to depict and characterize the type of injury. Plain radiographs and scintigraphy may fail to disclose the type and severity of the injury. In patients with normal initial plain radiographs, MR imaging can discriminate occult fractures from bone bruises and may also demonstrate ligamentous disruption. MR imaging can also discriminate the proximal pole viability versus avascular necrosis secondary to previous fracture, which is important for treatment planning. Treatment of non-united fractures with vascularized grafts can be evaluated with contrast-enhanced MR imaging. Idiopathic osteonecrosis or Preiser's disease was originally described after trauma. The non-traumatic disorders of the scaphoid include post-traumatic osteoarthritis, inflammatory bone marrow edema in patients with rheumatoid arthritis, and osteomyelitis. MR imaging is helpful in all the above disorders to demonstrate early bone marrow edema, cartilage degeneration and associated subchondral marrow changes. The most commonly found tumors in the scaphoid are usually benign and include enchondroma, osteoblastoma and osteoid osteoma. MR imaging is not mandatory for the initial diagnosis, which should be based on plain X-ray findings.

Differential regulation of axonal growth and neuromuscular junction assembly by HGF/c‐Met signaling

“…It is therefore increasingly common for MRI to be the next investigation in the work‐up of patients with a clinically suspected scaphoid fracture and normal radiographs. MRI is highly accurate for confirming or excluding the diagnosis of scaphoid fracture (11) and has a 100% negative predictive value in the immature skeleton (16). MRI has been shown to be a cost‐effective method for ruling out occult fractures and bone contusions, thereby avoiding unnecessary immobilization, follow‐up appointments, and radiation exposure (17).…”

“…In the presence of an established scaphoid fracture, MRI is well suited to diagnosing complications such as nonunion and avascular necrosis (AVN). Approximately 12% of scaphoid fractures fail to heal and progress to nonunion, requiring internal fixation and bone grafting (16). The criterion for bony union on MRI is the presence of normal signal intensity marrow crossing the previous fracture line.…”

“…The presence of a persistent fracture line with sclerosis at the fracture margins should raise the possibility of nonunion. Cystic change at the fracture margins is also suspicious for micro‐motion in the setting of nonunion (16) (Fig. 2).…”

Presier’s disease: idiopathic avascular necrosis of scaphoid in a case presenting with wrist pain in young male

“…5 In the absence of trauma, any areas of low-signal intensity on T1-weighted MR images should raise the suspicion of idiopathic AVN as the carpal bones do not show the same subchondral pattern of AVN as larger bones. 6 Treatment is provided according to the stage of the disease. Conservative management consist of immobilization in a plaster cast for 3 months and other modalities like arthroscopic debridement and radial osteotomy have been successful in early stage.…”

Extensor Tendon Rupture of the Index Finger Secondary to Avascular Necrosis of the Scaphoid: A Case Report

“…2). 1 Intra-operatively, the EIP tendon was noted to have ruptured distally to the scaphoid (Fig. 3), and the extensor digitorum communis was elongated.…”