Learning objectives
- clinical utility and reliability of MRI and other diagnostic imaging in occult scaphoid fractures,
role of MRI in a viability assessment,
newly proposed algorithm for complicated scaphoid fracture – which diagnostic imaging modality is the current standard and when to use it
- review of new insights: reliability of diagnosis and stability estimation of partial union of the scaphoid bone,
importance of other diagnostic imaging
- 3D-printing of scaphoid models,
automatic annotation tool (machine learning algorithms)
Background
The scaphoid fracture (SF) is the most common wrist fracture and it accounts for 2–7% of all body fractures.
Early diagnosis especially of a slightly or nondisplaced SF remains a problem because it is difficult to recognize it on X-ray (16% are missed on initial x-rays) and it may stay occult for 1–6 weeks.
A newly proposed algorithm suggests early MRI (7–14 days after injury) to exclude SF and avoid unnecessary immobilization.
Wijetunga and authors (2018) have proposed: after injury initial x-rays and immobilization.
7-14...
Imaging findings OR Procedure Details
A non-union scaphoid fracture is an unhealed fracture lasting more than 6 months after injury (non-union rate between 10–15%).
Untreated non-union SF can be stable (fibrotic) or unstable (cystic and sclerotic).
Previous studies have defined union when the bridging rate is at least 50%.
A recent study (Brekke,
2018) has shown that biomechanical strength and stability are already maintained with at least 25% of bridging.
It is of great importance to describe the exact location of the fracture line and dislocation.
There are many classification...
Conclusion
Cross sectional studies (MRI/CT) remain an invaluable part of early diagnostics,
especially in occult scaphoid fracture evaluation.
Technical improvements like computer-assisted surgery,
3D printing and automatic annotation tool,
are becoming more important particularly in complex non-union SF as part of the preoperative planning.
References
References:
1. Scand J Plast Reconstr Surg Hand Surg.
1999;33(4):423e426.
Howe LM.
Epidemiology of scaphoid fractures in Bergen,
Norway.
2. J Hand Surg Am.2018 Dec 14.The Use of Three-Dimensional Printing for ComplexScaphoidFractures.
Jew N,Lipman JD,Carlson MG
3.Curr Med Sci.2018 Dec;38(6):941-948.
Epub 2018 Dec 7.
Computer-assisted Surgery forScaphoidFracture.
Xiao ZR ,
Xiong G
4.Medicine (Baltimore).2018 Nov;97(48):e13266.
Surgical versus nonsurgical treatment forscaphoidwaistfracturewith slight or no displacement: A meta-analysis and systematic review.
Li H,Guo W,Guo S,Zhao S,Li R
5.J Hand Surg Asian Pac Vol.2018 Dec;23(4):450-462.
Surgical Strategy forScaphoidNonunion...
Personal Information
Milka Kljaic Dujic,
MD
Department of Radiology
University Medical Centre Maribor
[email protected]
Mitja Rupreht,
MD,
Phd
Department of Radiology
University Medical Centre Maribor
Jerneja Vidmar,
MD
Department of Plastic Surgery
University Medical Centre Maribor