Scaphoid Fractures: Whatʼs Hot, Whatʼs Not

Geissler, William B.; Adams, Julie E.; Bindra, Ranjna; Lanzinger, William D.; Slutsky, David J.

doi:10.2106/jbjs.942icl

Cited by 52 publications

(42 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Treatment of nonunion of the scaphoid remains a challenge in hand surgery, particularly when it involves the proximal pole or vascular impairment of the segments [5]. Success treating nonunion of the scaphoid is measured by consolidation, reestablishment of the shape of the scaphoid, pain relief, and recovery of the normal mobility and biomechanics of the wrist [24].…”

Section: Discussionmentioning

confidence: 99%

“…Non-union can show a distinct pattern of degenerative changes, eventually leading to a scaphoid non-union advanced collapse wrist [4]. In established non-union, the treatment goal, in addition to bone union with restoration of the shape of the scaphoid, should be to re-establish wrist function so that the patient can resume normal activities [5]. These are mostly related to fractures of the proximal pole or to avascular necrosis of the proximal fragment [6,7].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Scaphoid fracture nonunion: correlation of radiographic imaging, proximal fragment histologic viability evaluation, and estimation of viability at surgery

Bervian

Ribak

Livani

2014

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

Purpose The purpose of this study was to correlate the preoperative imaging, vascularity of the proximal pole, and histology of the proximal pole bone of established scaphoid fracture non-union. Methods This was a prospective non-controlled experimental study. Patients were evaluated pre-operatively for necrosis of the proximal scaphoid fragment by radiography, computed tomography (CT) and magnetic resonance imaging (MRI). Vascular status of the proximal scaphoid was determined intra-operatively, demonstrating the presence or absence of puncate bone bleeding. Samples were harvested from the proximal scaphoid fragment and sent for pathological examination. We determined the association between the imaging and intra-operative examination and histological findings. Results We evaluated 19 male patients diagnosed with scaphoid nonunion. CT evaluation showed no correlation to scaphoid proximal fragment necrosis. MRI showed marked low signal intensity on T1-weighted images that confirmed the histological diagnosis of necrosis in the proximal scaphoid fragment in all patients. Intra-operative assessment showed that 90 % of bones had absence of intra-operative puncate bone bleeding, which was confirmed necrosis by microscopic examination. Conclusions In scaphoid nonunion MRI images with marked low signal intensity on T1-weighted images and the absence of intra-operative puncate bone bleeding are strong indicatives of osteonecrosis of the proximal fragment.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Scaphoid fracture nonunion: correlation of radiographic imaging, proximal fragment histologic viability evaluation, and estimation of viability at surgery

Bervian

Ribak

Livani

2014

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

show abstract

“…We presume that midwaist and distal pole fractures need the same treatment whereas proximal pole fractures may need different treatment. Indeed Geissler et al [14] have shown there is a consensus in literature, in non-union of proximal pole fractures, that surgical treatment is needed.…”

Section: Discussionmentioning

confidence: 99%

Functional outcome in conservatively treated non-displaced scaphoid fractures

Drijkoningen¹,

Beeres²,

Leerdam³

et al. 2012

OJCD

View full text Add to dashboard Cite

Purpose: This study evaluated the functional outcome after conservative treatment of non-displaced scaphoid fractures using an international validated outcome scale (DASH). Methods and materials: Between 2005 and 2010, 60 patients with a non-displaced scaphoid fracture were included. When a patient visited the emergency department and was clinically suspected of a scaphoid fracture radiography was performed. If no fracture was diagnosed with this modality a CT or MRI-scan both in combination with bonescintigraphy was performed. Patients with scaphoid fractures diagnosed with CT/MRI and bonescintigraphy were treated with a six-week scaphoid forearm cast. Within 1 year after cast removal patients filled in the DASH questionnaire. Results: Sixty (80%) patients returned the DASH questionnaire at 12 months after treatment. Thirty-eight (63.3%) were male and the mean age was 35 (range 11 -83). Forty-four (73.3%) patients had a mid-waist fracture of the scaphoid, 13 (21.7%) had a fracture of the distal pole and three (0.05%) had a proximal fracture. Median DASH score at one year after the trauma was 6 (range 3 -15) for patients with a distal pole fracture and 5 (range 0 -21.5) for mid-waist fractures (p = 0.7, Table 2). For the three patients with a proximal scaphoid fracture the DASH scores appeared higher and were 83, 82 and 30 respectively. Conclusion: Conservative treatment for six weeks with a below the elbow cast is sufficient for the majority of patients with an occult distal or mid-waist scaphoid fracture and results in a good functional outcome according to the DASH questionnaire.

show abstract

“…The rate of misdiagnosis of scaphoid fractures is as high as 30% with conventional radiography[3]. Because internal fixation provides reasonable results, both patients and surgeons are willing to use intraosseous screw fixation to treat minimally and acutely displaced scaphoid fractures[4]. The goal of such treatment in young adults is to prevent carpal collapse and degenerative arthritis.…”

Section: Introductionmentioning

confidence: 99%

The Scaphoid Safe Zone: A Radiographic Simulation Study to Prevent Cortical Perforation Arising from Different Views

Hong

Chang

et al. 2017

PLoS ONE

View full text Add to dashboard Cite

PurposeThe purpose of this study was to simulate and calculate the probability of iatrogenic perforation of the scaphoid cortical bone when internal fixation appeared to be safe on radiographs. The results will assist surgeons in determining proper screw placement.MethodsThirty scaphoids were reconstructed using computed tomography data and image-processing software. Different central axes were determined by the software to simulate the surgical views. The safe zone (SZ) and risk zone (RZ) were identified on the axial projection radiographs by comparing the scaphoid bone stenosis measured by the fluoroscopic radiographs with a three-dimensional reconstruction of the scaphoid stenosis. Each original axial projection radiograph was zoomed and compiled to match a calculated average image. The RZ, SZ, and probability of perforations in various quadrants were calculated.ResultsUsing a volar view (approach), the mean risks of cortical perforation were 25% with screws and 36% with k-wires. Using a dorsal view (approach), the mean risks of cortical perforation were 18% with screws and 30% with k-wires. A high risk of perforation was detected at the ulnar–dorsal zone.ConclusionSurgeons should be wary of screws that appear to lie close to the scaphoid cortex on both anteroposterior (AP) and lateral radiographs, particularly in the ulnar–dorsal and radial–dorsal quadrants, because such screws are likely to perforate the cortex. The position of the internal fixator should be assessed using a diagram outlining the various SZs. Therapeutic, Level III.

show abstract

Scaphoid Fractures: Whatʼs Hot, Whatʼs Not

Cited by 52 publications

References 15 publications

Scaphoid fracture nonunion: correlation of radiographic imaging, proximal fragment histologic viability evaluation, and estimation of viability at surgery

Scaphoid fracture nonunion: correlation of radiographic imaging, proximal fragment histologic viability evaluation, and estimation of viability at surgery

Functional outcome in conservatively treated non-displaced scaphoid fractures

The Scaphoid Safe Zone: A Radiographic Simulation Study to Prevent Cortical Perforation Arising from Different Views

Contact Info

Product

Resources

About