Assessment of scaphoid fracture healing

Abstract

Scaphoid fractures are among the most common hand fractures in adults. The geometry of the scaphoid as it relates to its retrograde blood supply renders it particularly prone to avascular necrosis and other fracture complications. Though there has been long-standing debate over the optimal method of diagnosing scaphoid fractures, the best and most cost-effective methods combine clinical exam with other imaging modalities such as navicular view plain films, CT, and MRI for particularly questionable presentations. Once a scaphoid fracture is diagnosed, it should be followed by an orthopaedic surgeon and treated with cast immobilization or operative management in the case of displaced fractures. Fractures should be followed to monitor healing progress in order to ensure the eventual development of bridging bone across the fracture line, usually best appreciated on CT. Proper treatment of scaphoid fractures and assessment of fracture healing can minimize the occurrence of non-unions and associated arthritic changes.

Metallic Artifacts From Internal Scaphoid Fracture Fixation Screws

“…This reflects our clinical experience from daily routine where MDCT is the modality of choice in the evaluation of postoperative patients with internal fixated scaphoid bone fractures when imaging other than conventional radiography is required. 30,31 However, with the exception of qualitative ratings for artifact degree, FPCT standarddose acquisitions performed equal to MDCT. Used intraoperatively, FPCT mounted onto a fully mobile C-arm may therefore offer sufficient image quality to adequately ascertain screw position and fracture fragment adaption.…”

Computer-Assisted 3-Dimensional Reconstructions of Scaphoid Fractures and Nonunions With and Without the Use of Patient-Specific Guides: Early Clinical Outcomes and Postoperative Assessments of Reconstruction Accuracy

“…Multiplanar reconstruction and 3-dimensional CT have proven to be more accurate and reliable in quantifying scaphoid fragment displacement and diagnosing nonunion. 24,26e29 Nakamura et al 28 More recently, CT-reconstructed 3-dimensional triangular surface models have been used to compare malunited forearm bones with the normal contralateral anatomy. This approach may be the most appropriate for evaluating forearm deformities.…”

Diagnosis of scaphoid fracture: optimal imaging techniques

“…The clinical presentation of a scaphoid fracture is variable, but in nearly all cases there will be wrist pain and tenderness. Several clinical signs have been described, [46][47][48] such as snuff box tenderness, tenderness over the scaphoid tubercle, [49][50][51] or tenderness with axial compression of the first or second digits (the scaphoid compression test). 52 Combining the clinical tests improves the clinical diagnosis, which has a high sensitivity.…”