Undisplaced scaphoid waist fractures: is 4 weeks’ immobilisation in a below-elbow cast sufficient if a week 4 CT scan suggests fracture union?

Geoghegan, John M.; Woodruff, Michael J.; Bhatia, Ramya; Dawson, James; Kerslake, Robert; Downing, N. D.; Oni, J. A.; Davis, T. R. C.

doi:10.1177/1753193409105189

Cited by 56 publications

(44 citation statements)

References 16 publications

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“…suggested that below elbow cast immobilization for as little as four weeks may be sufficient treatment for undisplaced fractures, with 86% of patients showing fracture union on CT at four weeks. In this study, the majority of these patients (67%) had cast removed at four weeks and all fractures achieved union 23 . Rhemrev et al .…”

Section: Treatment Options and Outcomesmentioning

confidence: 56%

Review of treatment of acute scaphoid fractures: R1

Hickey

Hak

Logan

2012

ANZ Journal of Surgery

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Scaphoid fractures are common. Clinical suspicion and early diagnosis and treatment are vital in order to avoid complications such as avascular necrosis. The management of these fractures depends on fracture characteristics, specifically the degree of displacement. With consideration of patient factors, such as occupation, the treatment can be non-operative or operative. There has been much debate in the recent literature regarding the best management of these fractures. The purpose of this review was to identify the current evidence for non-operative and operative treatment. Undisplaced and minimally displaced fractures can be managed non-operatively with a scaphoid cast. Surgical treatment is used for fractures with displacement of >1 mm.

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Section: Treatment Options and Outcomesmentioning

confidence: 56%

Review of treatment of acute scaphoid fractures: R1

Hickey

Hak

Logan

2012

ANZ Journal of Surgery

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“…Geoghegan et al report success following 4 weeks of immobilization for undisplaced scaphoid waist fractures that have evidence of union or partial union on the CT scan at week 4 [18]. When clinical decisions are based on X-rays only, this may lead to prolonged, unnecessary immobilization or an unnecessary push towards surgery [18]. By determining the percentage of union for scaphoid fractures based on CT scan, we can more accurately follow these fractures as they progress through the phases of healing.…”

Section: Discussionmentioning

confidence: 99%

A quantitative definition of scaphoid union: determining the inter-rater reliability of two techniques

Grewal

Frakash

Osman

et al. 2013

Journal of Orthopaedic Surgery and Research

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BackgroundDespite extensive literature supporting the use of computerized tomography (CT) scans in evaluating scaphoid fractures, there has not been a consensus on the methodology for defining and quantifying union. The purpose of this study was to test the inter-observer reliability of two methods of quantifying scaphoid union.MethodsThe CT scans of 50 non-operatively treated scaphoid fractures were reviewed by four blinded observers. Each was asked to classify union into one of three categories, united, partially united, or tenuously united, based on their general impression. Each reviewer then carefully analyzed each CT slice and quantified union based on two methods, the mean percentage union and the weighted mean percentage union. The estimated percentage of scaphoid union for each scan was recorded, and inter-observer reliability for both methods was assessed using a Bland-Altman plot to calculate the 95% limits of agreement. Kappa statistic was used to measure the degree of agreement for the categorical assessment of union.ResultsThere was very little difference in the percentage of union calculated between the two methods (mean difference between the two methods was 1.2 ± 4.1%), with each reviewer demonstrating excellent agreement between the two methods based on the Bland-Altman plot. The kappa score indicated very good agreement (Ƙ = 0.80) between the consultant hand surgeon and the musculoskeletal radiologist, and good agreement (Ƙ = 0.62) between the consultant hand surgeon and the hand fellow for the categorical assessment of union.ConclusionsThis study describes two methods of quantifying and defining scaphoid union, both with a high inter-rater reliability. This indicates that either method can be reliably used, making it an important tool for both for clinical use and research purposes in future studies of scaphoid fractures, particularly those which are using union or time to union as their endpoint.Level of evidenceDiagnostic, level III

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“…If these show the fracture is undisplaced and appears to have united across 50 % of its cross section, then the fracture has almost certainly united suffi ciently to discard the cast and mobilise the wrist [ 31 ].…”

Section: Assessment Of Fracture Unionmentioning

confidence: 98%