Determining diagnosis of scaphoid healing: Comparison of cone beam CT and X-ray after six weeks of immobilization

Farracho, Lucia Calisto; Moutinot, Bérénice; Neroladaki, Angeliki; Hamard, Marion; Gorican, K; Poletti, Pierre–Alexandre; Beaulieu, Jean-Yves; Bouvet, Cindy; Boudabbous, Sana

doi:10.1016/j.ejro.2020.100251

Cited by 11 publications

(4 citation statements)

References 48 publications

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“…These fractures, however, were situated in the lower limb (foot, ankle, knee, hip) and elbow. At the wrist, Neubauer et al (28) were able to show that a dose optimization has even greater potential in multi-detector CT imaging in comparison to cone beam CT, which permits a detailed bony architecture but is limited due to a smaller FOV and increased scattered radiation (29). More recently, an excellent cortical outline of bone structures in simulated ULD-CT imaging was achieved in torsion measurements of the lower limbs and the results were confirmed in real ULD-CT imaging (14,15).…”

Section: Discussionmentioning

confidence: 99%

Ultra-low dose CT for scaphoid fracture detection—a simulational approach to quantify the capability of radiation exposure reduction without diagnostic limitation

Keller¹,

Hagen²,

Neubauer³

et al. 2022

Quant Imaging Med Surg

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Background: Modern CT might deliver higher image quality than necessary for fracture imaging, which would mean non-essential effective radiation exposure for patients. We simulated ultra-low dose (ULD)-CT at different dose levels and analyzed their diagnostic performance for scaphoid fracture detection.Methods: 30 consecutive high quality CT with clinically suspected scaphoid fractures were assessed. ULDsimulations were made at 20%, 10% and 5% of original dose. Three readers at different levels of experience (expert, moderate, inexperienced) expressed their diagnostic confidence (DC; 5-point-Likert-scale) and analyzed the presence and classification of scaphoid fractures within Krimmer's and Herbert's classifications.Effective radiation exposure of the original data sets and ULD-CT were calculated.Results: At 20% and 10% dose the more experienced readers reached perfect sensitivity (100%) and specificity (100%), showing perfect agreement regarding fracture classification (1.00). Diagnostic performance decreased at 5% dose (92.86% sensitivity, 100% specificity; expert reader). The inexperienced reader showed reduced sensitivity and specificity at all dose levels. At 10% dose minimal DC of all readers was 3/5 and mean calculated effective radiation exposure was 1.11 [±0.36] µSv. Conclusions:The results suggest that ULD-CT at 10% dose compared to high quality CT might offer sufficient image quality to precisely detect and classify scaphoid fractures, if moderate experience of the radiologist is granted.

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Section: Discussionmentioning

confidence: 99%

Ultra-low dose CT for scaphoid fracture detection—a simulational approach to quantify the capability of radiation exposure reduction without diagnostic limitation

Keller¹,

Hagen²,

Neubauer³

et al. 2022

Quant Imaging Med Surg

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show abstract

“…Evaluation of these angles will make it possible to evaluate a possible carpal instability and may influence the operative indication or the surgical management technique such as for scaphoid fractures for which the diagnosis of a scapholunate ligament lesion modifies the management and requires an arthroscopy in addition to osteosynthesis [23]. For radiological follow-up, CBCT is performed in most patients [24] with a carpal fracture to assess secondary fracture displacement and bone healing [25], both for fractures fixed by osteosynthesis and treated non-surgically. Under these Fig.…”

Section: Discussionmentioning

confidence: 99%

Reliability of radio-ulnar and carpal alignment measurements in the wrist between radiographs and 3D imaging

Branco

Bouvet²,

Hamard

et al. 2022

European Journal of Radiology

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“…X-ray is not reliable to determine fracture displacement and deformity [41], and wrong position of the hand and "overlining" in the fracture line can complicate the evaluation of union. CT scans are reportedly more accurate and reliable in the assessment of union[26, [42][43][44]. We aim to provide a more accurate measurement of time to union with repeated CT scans.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic versus open cancellous bone grafting for scaphoid delyed/nonunion in adults: study protocol for a randomized clinical trial

Kjaer

Rasmusssen

Gvozdenoviz

2022

Preprint

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Background: Scaphoid non-union results in pain and decreased hand function. Untreated, almost all cases develop degenerative changes. Despite advances in surgical techniques, the treatment is challenging and often results in a long period with a supportive bandage until the union is established. Open, corticocancellous (CC) or cancellous (C) graft reconstruction and internal fixation are often preferred. Arthroscopic assisted reconstruction with C chips and internal fixation provides minimal trauma to the ligament structures, joint capsule, and extrinsic vascularization with similar union rates. Correction of deformity after operative treatment is debated with some studies favouring CC, and other found no difference. No studies have compared time to union and functional outcomes in arthroscopic vs. open C graft reconstruction. We hypothesize that Arthroscopic assisted C chips graft reconstruction of scaphoid delayed/non-union provide faster time to union, by at least mean 3 weeks difference. Methods: Single site, prospective, observer-blinded randomized controlled trial. Eighty-eight patients aged 18-68 years with scaphoid delayed/non-union, will be randomized, 1:1, to either open iliac crest C graft reconstruction or arthroscopic assisted distal radius C chips graft reconstruction. Patients are stratified for smoking habits, proximal pole involvement, and displacement of >/<2mm. The primary outcome is time to union, measured with repeated CT scans at 2-week intervals from 6 to 16 weeks postoperatively. Secondary outcomes are Quick disabilities of the Arm, Shoulder and Hand (Q-DASH), Visual Analogue scale (VAS), donor site morbidity, union rate, restoration of scaphoid deformity, range of motion, key-pinch, grip strength, EQ5D-5L, patient satisfaction, complications, and revision surgery. Discussion: The results of this study will contribute to the treatment algorithm of scaphoid delayed/non-union and assist hand surgeons and patients in making treatment decisions. Eventually, improving time to union will benefit patients in earlier return to normal daily activity and reduce society costs by shortening sick leave. Trial registration: clinicaltrials.gov, NCT05574582

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Determining diagnosis of scaphoid healing: Comparison of cone beam CT and X-ray after six weeks of immobilization

Cited by 11 publications

References 48 publications

Ultra-low dose CT for scaphoid fracture detection—a simulational approach to quantify the capability of radiation exposure reduction without diagnostic limitation

Ultra-low dose CT for scaphoid fracture detection—a simulational approach to quantify the capability of radiation exposure reduction without diagnostic limitation

Reliability of radio-ulnar and carpal alignment measurements in the wrist between radiographs and 3D imaging

Arthroscopic versus open cancellous bone grafting for scaphoid delyed/nonunion in adults: study protocol for a randomized clinical trial

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