Partial Union of Acute Scaphoid Fractures

Singh, Harvinder; Forward, D. P.; Davis, T. R. C.; Dawson, James; Oni, J. A.; Downing, N. D.

doi:10.1016/j.jhsb.2005.05.007

Cited by 94 publications

(77 citation statements)

References 12 publications

(19 reference statements)

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“…Moreover, the diagnosis of scaphoid union was ascertained with use of radiographs, which have poor reliability 40 . Computed tomography seems to be the most reliable imaging technique for predicting scaphoid fracture union and should therefore be used as a reference standard for healing 41 .…”

Section: Key Findingsmentioning

confidence: 99%

Surgical Compared with Conservative Treatment for Acute Nondisplaced or Minimally Displaced Scaphoid Fractures

Buijze

Doornberg

Ham

et al. 2010

The Journal of Bone and Joint Surgery-American Volume

115

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Section: Key Findingsmentioning

confidence: 99%

Surgical Compared with Conservative Treatment for Acute Nondisplaced or Minimally Displaced Scaphoid Fractures

Buijze

Doornberg

Ham

et al. 2010

The Journal of Bone and Joint Surgery-American Volume

115

View full text Add to dashboard Cite

“…CT allows an exact view of the sub-millimeter anatomy of the fracture gap where endosteal bone regeneration exclusively occurs [7,15,19]. In the first 4 weeks there is physiological descaling on the fragment margins, making the gap appear widened.…”

Section: Resultsmentioning

confidence: 99%

“…After a scaphoid fracture has consolidated the former fracture zone in the MRI is highly dependent on the local degree of sclerosis. The fracture region can appear hyperintense if fatty bone marrow has developed, or hypointense if a sclerotic zone has formed [19]. Because of this, MRI-based diagnosis cannot be used for assessing fracture union and progression, since signal interference can be associated with both consolidated and non-consolidated scaphoid fractures.…”

Section: Resultsmentioning

confidence: 99%

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Imaging of Scaphoid Fractures According to the New S3 Guidelines

Schmitt

Rosenthal

Unfallchirurgie³

2016

Fortschr Röntgenstr

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▼Up to 30 % of acute scaphoid fractures are missed in conventional radiography. CT and MRI should be early performed in the diagnostic workflow, when radiograms (dorsopalmar, lateral and Stecher's views) are negative or inconclusive in fracture detection. Significance of CT is different from that of MRI: Sensitivity of CT imaging (85 to 95 %) is superior to conventional radiography (about 70 %), but inferior to MRI (almost 100 %). However, CT (specificity 95 to 100 %) is able to provide more detailed anatomic information of the fracture pattern when compared to MRI (specificity 80 to 90 %). Particularly, differentiation of bone contusion ("bone bruise") and non-displaced fracture can be difficult in MRI. Thus, CT indication is not only given for fracture detection, but also for assessing the morphology in scaphoid fractures (localization, fragment dislocation, comminuted zones) and the fragment instability, too. MRI should be limited to equivocal trauma cases presenting pain in the snuff box, but with inconclusive CT findings. In CT and MRI of scaphoid fractures, image display must be aligned along the longitudinal extension of the scaphoid, either by acquiring or reformatting oblique-sagittal and obliquecoronal planes. Key points ▶ Radiography can be limited to the dorsopalmar, lateral and Stecher's views in scaphoid fractures.▶ In CT and MR imaging, the dedicated anatomy of the scaphoid has to be covered with oblique-sagittal and oblique-coronal images.

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“…10 This concern was investigated in a study in which patients with acute scaphoid waist fractures were treated non-operatively in a plaster for 8-12 weeks before undergoing CT to assess union and malunion. 1 Malunion was assessed from the CT using the height-to-length ratio, which appeared the most reproducible measure of this parameter. Patients were recalled at 1 year for a clinical assessment that was performed by an assessor who was totally unaware of the radiological outcome and whether the fracture had (or had not) united with malunion.…”

Section: Studymentioning

confidence: 99%

Prediction of outcome of non-operative treatment of acute scaphoid waist fracture

Davis

2013

annals

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Fifteen per cent of acute fractures of the scaphoid waist fail to unite if treated non-operatively in plaster, resulting in persistent loss of function. Suspected risk factors for non-union include proximal fracture fragment avascularity and assessments of fracture displacement and comminution. This series of studies investigated whether one can accurately identify which scaphoid waist fractures will unite with plaster treatment. They suggest that proximal fracture fragment vascularity is not a predictor of outcome. In contrast, assessments of fracture displacement on magnetic resonance imaging (MRI) and computed tomography (CT) but not scaphoid series radiographs can be used to predict outcome. Undisplaced fractures are benign and unite reliably with 4-8 weeks' treatment in plaster. Displaced fractures with 3mm or more gapping have a significant nonunion rate if treated in plaster and might be better treated operatively. Use of MRI/CT may allow reliable, cost effective treatment of acute fractures through the scaphoid waist.The aim of treatment of scaphoid waist fractures is to achieve union. This is because one can then expect restoration of normal, painless wrist function within 6-12 months with no risk of late onset wrist osteoarthritis if the fracture unites. In contrast, there is often persistent pain and loss of wrist movement and function if the fracture fails to unite. Additionally, there is then a significant risk of symptomatic post-traumatic osteoarthritis in future years.It is often difficult to decide whether a scaphoid fracture has united 1 but research suggests that 85% or more of scaphoid waist fractures unite with treatment in a below elbow plaster cast for 8-12 weeks.2 This is still the standard management of these fractures in the UK. About 50% of units continue to use a scaphoid plaster, which immobilises the thumb but others, Nottingham included, use a Colles type plaster, which leaves the thumb free and allows better function. 3Although non-operative treatment of scaphoid fractures is the standard in the UK, it is becoming increasingly fashionable to treat these fractures operatively. It is argued that this benefits the patient because it avoids the need for lengthy immobilisation of the wrist in plaster. However, it has never been shown that operative treatment improves the union rate. Furthermore, there is no doubt that, in the hands of mere mortals, operative fixation has a significant complication rate that is mainly due to problems with screw placement. Finally, in the current financial climate, one has to ask if operative fixation of a fracture that usually unites with plaster treatment is cost effective. Although it is claimed that it is cost effective, operative fixation at best only reduces indirect costs, and only if non-operative treatment in plaster is continued for many weeks. Surgeons who favour operative fixation highlight the 15% non-union rate with treatment on plaster 2 as a reason for operative fixation. In contrast, those who favour plaster treatment argue that ...

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Partial Union of Acute Scaphoid Fractures

Cited by 94 publications

References 12 publications

Surgical Compared with Conservative Treatment for Acute Nondisplaced or Minimally Displaced Scaphoid Fractures

Surgical Compared with Conservative Treatment for Acute Nondisplaced or Minimally Displaced Scaphoid Fractures

Imaging of Scaphoid Fractures According to the New S3 Guidelines

Prediction of outcome of non-operative treatment of acute scaphoid waist fracture

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