Keywords:
Trauma, Diagnostic procedure, MR, Musculoskeletal system, Musculoskeletal soft tissue, Musculoskeletal bone
Authors:
I. Katsimilis, N. Purohit, L. King, M. Sampson, V. T. Skiadas; Southampton/UK
DOI:
10.1594/essr2015/P-0096
Background
The scaphoid bone is the most commonly fractured carpal bone.
It occurs most often in young adults,
mainly young active men.
The primary mechanism of injury is a fall on the outstretched hand with an extended and radially deviated wrist,
resulting in extreme dorsiflexion at the wrist and axial loading of the radial side of the hand.
Clinically it presents with radial sided wrist pain,
swelling,
anatomical snuffbox tenderness,
scaphoid tubercle tenderness and positive scaphoid compression test.
The differential diagnosis for suspected scaphoid fractures includes fractures of other carpal bones,
metacarpals or distal radius,
intrinsic ligament injuries,
aggrevated osteoarthritis changes and tendon abnormalities.
Clinical examination for caphoid fracture is sensitive but have relatively low specificity.
Initial radiographs including anteroposterior,
lateral,
oblique,
and scaphoid views do not always detect scaphoid fractures.
Although in equivocal cases an MRI scan is mainly performed in order to exclude or confirm a scaphoid fracture,
other osseous or soft tissue abnormalities mimicking a scaphoid fracture can be found and alter the patient’s management.
Timely diagnosis in these cases,
as well as of occult scaphoid factures,
can secure a successful treatment and often decrease the likelihood of adverse outcome and complications.
Although a formal cost analysis is beyond the scope of this study,
several studies show that the early use of MRI is cost effective in managing occult scaphoid fractures and related injuries.