Keywords:
Education and training, Education, Diagnostic procedure, Complications, MR, Trauma, Musculoskeletal system, Musculoskeletal bone
Authors:
M. Kljaic Dujic, J. Vidmar, M. Rupreht; Maribor/SI
DOI:
10.26044/essr2019/P-0136
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 days after immobilization,
in still clinical suspected SF,
the second x-rays.
If they are negative for SF fracture immediate MRI as “gold standard”.
If in the MRI images there are no scaphoid bone edema,
scaphoid fracture can be exclude.
According to this article the sensitivity of x-ray is 60-70% and MRI/CT is higher than 95% - the utility of cross-sectional imaging remains important and almost irreplaceable in nondisplaced SF.
So,
with early MRI/CT we are try to avoid delayed diagnosis of nondisplaced SF and also to avoid unnecessary long immobilization.
10% of scaphoid fractures are concomitant with a fracture of other carpal bones as capitate or lunate bone.
Beside fractures of other bones,
unlike CT,
MRI can exclude other soft tissue injuries as well.
Cheema and authors (2018) have accentuated importance of reformatting CT scans in right planes for correct measurements of deformity and displacement in SF.
Measurements can be made in both plane (longitudinal and axial) with comparative accuracy.
The role of other diagnostic imaging like ultrasound in routine clinical use still remains unclear.
Kwee and authors (2018) in their review article of 7 studies (total number of 314 patients) have shown that ultrasound can increase diagnostic reliability even in occult scaphoid fractures.
Some recent studies (Pianta and authors,
2018) have underlined usefulness of contrast enhanced dual-energy CT in scaphoid osteonecrosis evaluation using perfusion algorithm.