Using Computed Tomography to Assist With Diagnosis of Avascular Necrosis Complicating Chronic Scaphoid Nonunion

Smith, Michael L.; Bain, Gregory I.; Chabrel, N.; Turner, Perry C.; Carter, Chris; Field, John

doi:10.1016/j.jhsa.2009.02.016

Cited by 43 publications

(24 citation statements)

References 17 publications

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“…Humpback deformity of the scaphoid can be detected by measuring the lateral intrascaphoid angle on sagittal CT scans [28]. The lateral intrascaphoid angle is less than 35°in patients with a normal scaphoid, and an angle of greater than 45°is believed to promote pain, stiffness, and posttraumatic arthritis [2,16,26]. A scapholunate angle greater than 60°or a radiolunate angle greater than 30°on plain radiographs indicates a DISI deformity.…”

Section: Discussionmentioning

confidence: 99%

“…To correct these deformities, we believe some kinds of wedge bone graft should be applied by open procedure. Although MRI scans are considered the gold standard to detect osteonecrosis of the proximal scaphoid fragment, a recently published report indicated preoperative longitudinal CT scanning is also valuable for identifying osteonecrosis [26]. Vascularized bone grafting should be considered in patients with osteonecrosis of the proximal scaphoid fragment.…”

Section: Discussionmentioning

confidence: 99%

“…Fracture location, displacement, lateral intrascaphoid angle, which is formed by lines perpendicular to the articular surface of the proximal and distal pole ( Fig. 1) [26], and DISI were recorded. DISI [28] was considered present when the scapholunate angle was greater than 60°or the radiolunate angle was greater than 30°.…”

Section: Methodsmentioning

confidence: 99%

“…Osteoarthritis was graded as follows: (1) Stage I, affecting the radial styloidscaphoid junction; (2) Stage II, affecting the entire radioscaphoid joint; (3) Stage III, affecting the entire radioscaphoid joint and capitolunate joint; and (4) Stage IV, affecting the radiocarpal and intercarpal joints [29]. Osteonecrosis was considered present when we observed increased absolute or relative density in the proximal pole of the scaphoid [26].…”

Section: Methodsmentioning

confidence: 99%

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Volar Percutaneous Screw Fixation for Scaphoid Waist Delayed Union

Kim

Lee

2010

Clinical Orthopaedics &Amp; Related Research

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Volar percutaneous cannulated screw fixation of acute scaphoid waist fractures reportedly produces high rates of healing and early return to work, but the method has not been reported for treating scaphoid waist delayed unions. We therefore report the surgical results of percutaneous screw fixation in scaphoid waist delayed union in 12 patients. All patients were male with an average age of 31.1 years. Duration of injury was 12 weeks (range, 6-20 weeks). However, no patient had carpal instability, scaphoid deformity, or avascular necrosis of the proximal fracture fragment. The minimal followup was 12 months (mean, 20 months; range, 12-24 months). Preoperative radiographs showed slight bone resorption at the fracture site in five patients and cyst formation in three patients. A cannulated screw was introduced volarly under image intensifier guidance in all patients. All fractures united uneventfully. At 12 month followups, the flexion and extension arcs of the injured wrist were 94% and 93% of the uninjured wrist. Grip strength averaged 34 ± 3 kg, which was 92% of the grip strength of the uninjured hand.The Mayo Modified Wrist Score was 94 ± 6 points and the Disabilities of the Arm, Shoulder, and Hand score was 9 ± 6 points. Our experience suggests volar percutaneous screw fixation is a reliable method to treat scaphoid waist delayed union.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Volar Percutaneous Screw Fixation for Scaphoid Waist Delayed Union

Kim

Lee

2010

Clinical Orthopaedics &Amp; Related Research

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“…Radiography, computed tomography (CT), and magnetic resonance imaging (MRI) are pre-operative diagnostic tests for avascular necrosis of the scaphoid [14,15]. MRI might be the most accurate, but it is not infallible [16].…”

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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Imaging of Wrist Trauma

Raby

2013

Medical Radiology

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Using Computed Tomography to Assist With Diagnosis of Avascular Necrosis Complicating Chronic Scaphoid Nonunion

Cited by 43 publications

References 17 publications

Volar Percutaneous Screw Fixation for Scaphoid Waist Delayed Union

Volar Percutaneous Screw Fixation for Scaphoid Waist Delayed Union

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

Imaging of Wrist Trauma

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