Review of the current methods in the diagnosis and treatment of scaphoid fractures

Krasin, Elisha; Goldwirth, M.; Gold, Aviram; Goodwin, David

doi:10.1136/pmj.77.906.235

Cited by 44 publications

(28 citation statements)

References 18 publications

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“…It is generally accepted that advanced imaging modalities are needed in case of suspected scaphoid fractures and negative radiographs in order to rule out a scaphoid fracture. It is known that missed diagnosis and inadequate treatment of this fracture leads to nonunion and may cause pain and serious disability [7,[10][11][12][13][14]. However, little is known on the clinical consequence of missing those other fractures which are detected in this study.…”

Section: Discussionmentioning

confidence: 43%

“…Patients who visited the Emergency Department with an acute trauma and a suspected scaphoid fracture after physical examination but no evidence of a scaphoid fracture on plain radiographs underwent at our institution bone scintigraphy [5][6][7][8][9][10][11]. We noticed that bone scintigraphy detected many other occult carpal and distal radius fractures in these patients with a suspected scaphoid fracture.…”

Section: Introductionmentioning

confidence: 96%

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Occult Fractures in the Carpal Region: Incidental Findings on Bone Scintigraphy

Zoakman¹,

Leerdam²,

Beeres³

et al. 2013

OJO

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The aim of this study was to evaluate the number and distribution of fractures around the wrist found on bone scintigraphy in patients with a clinically suspected scaphoid fracture and negative initial radiographs. We retrospectively included 445 consecutive patients with a suspected scaphoid fracture who underwent routine bone scintigraphy. None of the radiographs showed evidence of a fracture. We analyzed the type and number of other fractures incidentally found on bone scintigraphy. On average, bone scintigraphy was done in 4 days (1 -9). The outcome of bone scintigraphy: 80 (18.0%) a scaphoid fracture, 145 (32.6%) another fracture in the carpal region, 208 (46.7%) normal and the diagnosis of 12 (2.8%) was unclear. In the present study, we demonstrated that in patients with a clinically suspected scaphoid fracture and negative initial radiographs, bone scintigraphy detected in many cases (64.4%) other fractures in the carpal region. This suggests that radiographs not only miss scaphoid but also many other carpal and distal radius fractures. Solutions should be found to solve this problem and probably advanced imaging techniques like CT, MRI or bone scintigraphy should be used in the correct clinical scenario.

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Section: Discussionmentioning

confidence: 43%

Section: Introductionmentioning

confidence: 96%

Occult Fractures in the Carpal Region: Incidental Findings on Bone Scintigraphy

Zoakman¹,

Leerdam²,

Beeres³

et al. 2013

OJO

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“…Acute scaphoid fractures are typically seen in young adults who fall on the outstretched hand [7,25] . Patients who suffer from an acute scaphoid fracture are almost always part of the working population [25,28] . Therefore an early identification of the injury can help to enable a fast return to work and therefore reduce the injury related socioeconomic impact.…”

Section: Resultsmentioning

confidence: 99%

Comparison of conventional radiography and MDCT in suspected scaphoid fractures

Behzadi

Karul

Henes

et al. 2015

WJR

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AIM:To determine the diagnostic accuracy and radiation dose of conventional radiography and multidetector computed tomography (MDCT) in suspected scaphoid fractures. METHODS:One hundred twenty-four consecutive patients were enrolled in our study who had suffered from a wrist trauma and showed typical clinical symptoms suspicious of an acute scaphoid fracture. All patients had initially undergone conventional radiography. Subsequent MDCT was performed within 10 d because of persisting clinical symptoms. Using the MDCT data as the reference standard, a fourfold table was used to classify the test results. The effective dose and impaired energy were assessed in order to compare the radiation burden of the two techniques. The Wilcoxon test was performed to compare the two diagnostic modalities. RESULTS:Conventional radiography showed 34 acute fractures of the scaphoid in 124 patients (42.2%). Subsequent MDCT revealed a total of 42 scaphoid fractures. The sensitivity of conventional radiography for scaphoid fracture detection was 42.8% and its specificity was 80% resulting in an overall accuracy of 59.6%. Conventional radiography was significantly inferior to MDCT (P < 0.01) concerning scaphoid

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“…The localisation of the IRU around the fracture lines corresponds with previously described patterns of radiopharmaceutical uptake in cases of palmar process fracture (Keegan and others 1993, Robson and others 2008). IRU associated with human scaphoid fractures has been shown to be visible on scintigraphy from as early as 24 hours postinjury; however, associated trauma can lead to false positive results (Krasin 2001). Four days postinjury is the preferred interval for nuclear scintigraphy in these patients (Murphy and others 1995).…”

Section: Discussionmentioning

confidence: 99%

Biaxial plantar process fractures of the distal phalanx in a horse

Meehan

Cillán‐García

Parker

2014

Vet Record Case Reports

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A mature horse was presented for investigation of severe acute hindlimb lameness with soft tissue swelling, a full thickness wound to the dorsal metatarsus and no other localising signs. Survey radiographs of the metatarsophalangeal region were unremarkable. Nuclear scintigraphy was required to reach a diagnosis of biaxial plantar process fractures of the distal phalanx, which to the authors’ knowledge is previously unreported. Flexed dorsal 45° lateral-plantaromedial and flexed dorsal 45° medial-plantarolateral oblique projections confirmed the diagnosis of both a type I and II fracture in the same foot. Treatment with cast immobilisation and corrective farriery was successful, and the horse became sound at six-month follow-up.

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Review of the current methods in the diagnosis and treatment of scaphoid fractures

Cited by 44 publications

References 18 publications

Occult Fractures in the Carpal Region: Incidental Findings on Bone Scintigraphy

Occult Fractures in the Carpal Region: Incidental Findings on Bone Scintigraphy

Comparison of conventional radiography and MDCT in suspected scaphoid fractures

Biaxial plantar process fractures of the distal phalanx in a horse

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