Proximal Pole Scaphoid Fractures: A Computed Tomographic Assessment of Outcomes

Grewal, Ruby; Lutz, Kristina; MacDermid, Joy C.; Suh, Nina

doi:10.1016/j.jhsa.2015.10.013

Cited by 41 publications

(29 citation statements)

References 22 publications

(28 reference statements)

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“…Grewal et al evaluated union using two methods of evaluating CT scans and later used this method to evaluate different variables effect on healing time. 25,26 We used radiographs and clinical findings such as tenderness over the snuffbox to determine union. Though the same system was used for both groups of Abbreviations: KW, Kirschner wire; SD, standard deviation.…”

Section: Discussionmentioning

confidence: 99%

Intramedullary Screw and Kirschner Wire Fixation for Unstable Scaphoid Nonunion

Allon

Kramer

Wollstein³

2016

J Hand Microsurg

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Section: Discussionmentioning

confidence: 99%

Intramedullary Screw and Kirschner Wire Fixation for Unstable Scaphoid Nonunion

Allon

Kramer

Wollstein³

2016

J Hand Microsurg

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“…While Krimmer et al proposed a CT-based classification of scaphoid fractures based on fracture location and stability of the fracture pattern, a specific definition of the boundaries of the proximal pole is not stated; throughout the literature, the proximal pole has ranged from the proximal one-fifth to the proximal one-third of the scaphoid. 3,[22][23][24][25][26] Therefore, for the purpose of this study, a proximal pole scaphoid fracture was defined as the majority of the fracture line located proximal to the head of the capitate. Patient demographics, mechanism of injury, pre-and postoperative imaging, and operative reports were reviewed and recorded (►Table 1).…”

Section: Methodsmentioning

confidence: 99%

Outcomes of Local Bone Graft and Fixation of Proximal Pole Scaphoid Nascent Nonunions and Nonunions

et al. 2020

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Background Fractures of the proximal pole of the scaphoid have an increased risk of nonunion due to its tenuous blood supply. The optimal treatment of proximal pole scaphoid nonunions remains controversial. Objectives To review a single surgeon's experience with proximal pole scaphoid nascent nonunions (delayed unions) and nonunions that underwent surgical fixation with a cannulated headless compression screw and local autologous bone graft from the distal radius. Patients and Methods After obtaining Institutional Review Board approval, the electronic medical record of one tertiary care center was queried for patients with the diagnosis of “proximal pole scaphoid fractures” who underwent surgical fixation by a single surgeon over an 11-year period (2006–2017). Fifteen patients met initial query criteria; upon review of records, four patients were excluded due to the acute nature of the fracture, and one was excluded as surgical fixation included a vascularized bone graft. Results The final study cohort consisted of 10 patients with a total of 10 proximal pole scaphoid nonunions. Almost all of the patients in this study were male (9/10 [90%]), and sporting activities were the most common mechanism of injury (8/10 [80%]). Volumetric measurements of the scaphoid fractures on computed tomography (CT) revealed that the mean total volume of the scaphoid was 2.4 ± 0.48 cm3 and the mean volume of the proximal pole fragment was 0.38 ± 0.15 cm3. Postoperative CT scans were performed at a mean of 12.4 weeks (range: 8–16 weeks), with seven (7/10 [70%]) showing signs of complete union and three (3/10 [30%]) demonstrating partial union. None of the patients required additional procedures and there were no complications. Conclusions Our results suggest that proximal pole scaphoid fractures with delayed union and nonunion treated with surgical fixation and autologous local bone graft heal without the need for more complex vascularized procedures. The volume of the proximal pole fragment did not correlate with increased risk of ongoing nonunion after the index procedure. Level of Evidence This is a Level IV, case series study.

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“…Of 13 studies analyzed, four were prospective [5,[21][22][23], and six retrospective [18,19,[24][25][26][27], one of which focused on proximal pole fractures [26]. These studies included a total of 1603 acute scaphoid fractures.…”

Section: Scaphoid Fractures In Adultsmentioning

confidence: 99%

“…In addition, three register studies encompassed 35 493 scaphoid fractures [20,28,29]. In the majority of studies, the fracture diagnosis was based on conventional radiographs, while in two studies [21,22] it was based on CT and MRI combined, and one study [26], with focus on proximal pole fractures, CT was used for diagnosis. The most common trauma mechanism included a fall onto an outstretched hand during sports.…”

Section: Scaphoid Fractures In Adultsmentioning

confidence: 99%

Epidemiology of scaphoid fractures and non-unions: A systematic review

Jørgsholm¹,

Ossowski

Thomsen

et al. 2020

Handchir Mikrochir Plast Chir

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Background The scaphoid is the most commonly fractured carpal bone in adults as well as in children. Previous studies have reported a wide range of fracture incidences. Scaphoid fractures and non-unions in children have been sparsely investigated. Aim To perform a systematic review of the current literature on epidemiology of scaphoid fractures and non-unions in adults and children. Methods An electronic literature search was conducted investigating all studies in the literature published between January 1989 and June 23 2020. The systematic review following the PRISMA guidelines and searching in PubMed, Embase, Web of Science and Cochrane library databases was done in June 2020. Results 42 studies met our inclusion criteria, 6 studies were prospective, 32 were retrospective and 4 were register studies. The majority of studies relied on conventional radiographs for diagnosis. Scaphoid fractures in adults are predominately found in males with a peak incidence in the age group from 20 to 29 years. Incidence rates in males are reported from 107 to 151/100 000. Females have an earlier peak, in the age group 10 to 19 years, with an incidence from 14 to 46/100 000. Most fractures occur in the middle third of the scaphoid representing 60–69 % of cases. Scaphoid fractures in children are predominately found in boys age 12 and above, while it seldomly occur for children younger than 9 years. In adults the risk for developing a scaphoid non-union is between 2 % and 5 %, the majority affecting males and predominately located at the middle third of the scaphoid. Non-unions among children are rare and mainly due to missed or delayed diagnosis of a fracture in the middle third of the scaphoid. Conclusion This review revealed a substantial heterogeneity among studies concerning study population, diagnosis criterial and outcome measures. Currently, evidence on epidemiology for scaphoid fractures and non-unions are low.

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Proximal Pole Scaphoid Fractures: A Computed Tomographic Assessment of Outcomes

Abstract: Prognostic IV.

Cited by 41 publications

References 22 publications

Intramedullary Screw and Kirschner Wire Fixation for Unstable Scaphoid Nonunion

Intramedullary Screw and Kirschner Wire Fixation for Unstable Scaphoid Nonunion

Outcomes of Local Bone Graft and Fixation of Proximal Pole Scaphoid Nascent Nonunions and Nonunions

Epidemiology of scaphoid fractures and non-unions: A systematic review

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