Type:
Educational Exhibit
Keywords:
Outcomes, eLearning, MR, CT, Conventional radiography, Musculoskeletal bone, Management
Authors:
V. Gonzalez Mendez1, A. Alcalá-Galiano Rubio1, A. Merina1, D. Plata Ariza1, A. Bermejo Moríñigo1, C. Merino Sanchez1, A. Marin Toribio2; 1Madrid/ES, 2MADRID, MA/ES
DOI:
10.26044/ecr2019/C-1636
Background
The scaphoid bone is the most commonly fractured carpal bone,
accounting for 75% of all carpal bone fractures.
This type of fracture occurs often after a fall on an outstretched hand.
The initial radiography is negative or inconclusive in 10-25%.
These fractures usually occur in young individuals with a high functional demand and associate a high rate of complications,
such as non-union,
osteonecrosis and posttraumatic arthritis.
Therefore,
an early diagnosis is essential for a proper choice of treatment and an improvement in prognosis.
Scaphoid fractures have been classified according to various criteria.
While the May and Russe classifications are based on anatomical criteria,
the Herbert classification (Fig.
1) introduces the concept of stability (Fig. 2) (Fig. 3),
which may be helpful in determining the treatment options.
![](https://epos.myesr.org/posterimage/esr/ecr2019/147278/media/809809?maxheight=300&maxwidth=300)
Fig. 1: Herbert Classification
References: Deparment of Radiology, Hospital Universitario 12 de Octubre, Madrid
Before introducing the therapeutic possibilities,
some considerations must be highlighted.
The therapeutic indication is based on the concept of morphological stability; spatial geometry alterations (form and volume) of the scaphoid bone result in wrist instability.
Stability criteria of the Mayo Clinic proposed by Cooney et al [2] (Fig. 4 )
- Displacement > 1 mm
- Significant bone loss or fragmentation
- Scapho-lunate angle > 60º
- Radio-lunate angle < 15º
- Intraescapoid angle > 35 º
- Fractures causing dorsal intercalated segment instability (DISI)
- Associated perilunate injuries
Some authors consider any complete fracture of the scaphoid bone potentially unstable.