scholarly journals Importance of Computed Tomography in Determining Displacement in Scaphoid Fractures

2017 ◽  
Vol 07 (01) ◽  
pp. 038-042 ◽  
Author(s):  
Emily Gilley ◽  
Sameer Puri ◽  
Krystle Hearns ◽  
Andrew Weiland ◽  
Michelle Carlson
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Interobserver Reliability ◽  
Scaphoid Fracture ◽  
High Rate ◽  
Radiographic Evaluation ◽  
Angular Deformity ◽  
Level Of Evidence ◽  
Scaphoid Fractures ◽  
The Mean

Background Displaced scaphoid fractures have a relatively high rate of nonunion. Detection of displacement is vital in limiting the risk of nonunion when treating scaphoid fractures. Questions/Purpose We evaluated the ability to diagnose displacement on radiographs and computed tomography (CT), hypothesizing that displacement is underestimated in assessing scaphoid fracture by radiograph compared with CT. Materials and Methods Thirty-five preoperative radiographs and CT scans of acute scaphoid fractures were evaluated by two blinded observers. Displacement and angular deformity were measured, and the fracture was judged as displaced or nondisplaced. Scapholunate, radiolunate, and intrascaphoid angles were measured. Radiograph and CT measurements between nondisplaced and displaced fractures were compared. Intraobserver reliability was measured. Results  Reader 1 identified 12 fractures as nondisplaced on radiograph, but displaced on CT (34%). Reader 2 identified 9 fractures as nondisplaced on radiograph, but displaced on CT (26%). For displaced fractures, the mean intrascaphoid angle was over three times greater when measured on CT than on radiograph (56 vs. 16 degrees). Scapholunate angle >65 degrees and radiolunate angle >16 degrees were significantly associated with displacement on CT. Interobserver reliability for diagnosing displacement was perfect on CT but less reliable on radiograph. Conclusion Scaphoid fracture displacement on CT was identified in 26 to 34% of fractures that were nondisplaced on radiograph, confirming that radiographic evaluation alone underestimates displacement. These results underscore the importance of CT scan in determining displacement and angular deformity when evaluating scaphoid fractures, as it may alter the decision on treatment and surgical approach to the fracture. We recommend considering CT scan to evaluate all scaphoid fractures. Level of Evidence Level III.

scholarly journals Scaphoid Fracture Patterns—Part Two: Reproducibility and Demographics of a Simplified Scaphoid Fracture Classification

2019 ◽  
Vol 08 (06) ◽  
pp. 446-451
Author(s):  
Tessa Drijkoningen ◽  
Amin Mohamadi ◽  
Wouter F. van Leeuwen ◽  
Yonatan Schwarcz ◽  
David Ring ◽  
...  
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Interobserver Reliability ◽  
Scaphoid Fracture ◽  
Fracture Classification ◽  
Proximal Pole ◽  
Level Of Evidence ◽  
Related Factors ◽  
Scaphoid Fractures ◽  
Fracture Patterns

Abstract Objective To analyze the reproducibility, reliability, and demographics of a simplified anatomical scaphoid fracture classification based on posteroanterior radiographs using a large database of scaphoid fractures. Methods The study consisted of a retrospective review of electronic medical records of 871 consecutive patients. All patients presented between 2003 and 2014 at two centers. Patient- and surgeon-related factors were analyzed. Additionally, interobserver reliability of the Herbert and simplified scaphoid fracture classifications were tested. Results Proximal pole fractures were defined as fractures in which the center of the fracture line was proximal to the distal scapholunate interval (n = 30), waist fractures (n = 802) were defined as fractures involving the scaphocapitate interval, and distal tubercle fractures (n = 39) were defined as fractures involving the scaphotrapeziotrapezoid (STT) interval. The interobserver reliability of the simplified classification was fair (κ = 0.37) as for the Herbert classification (κ = 0.31). The average doubt of the answers of the observers was 2.1 on a scale from 0 to 10 for the simplified classification and 3.6 for the Herbert classification (P < 0.05). Conclusions All complete fractures across the entire scaphoid distal to the scapholunate articulation and proximal to the STT joint can be classified as waist fractures; nonwaist scaphoid fractures are uncommon (6%) and have somewhat different presentations compared to waist fractures. Simplifying the fracture classification slightly improves interobserver reliability, although remaining fair, and significantly reduces doubt. Level of Evidence This is a Level III, prognostic study.

Determining On-/Off-track Lesions in Glenohumeral Dislocation Using Multiplanar Reconstruction Computed Tomography Is Easier and More Reproducible Than Using 3-dimensional Computed Tomography

2020 ◽  
Vol 49 (1) ◽  
pp. 137-145
Author(s):  
Laura Irène C. Mulleneers ◽  
Hannah Van Rompaey ◽  
Baïdir Haloui ◽  
Nicole Pouliart
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Interobserver Reliability ◽  
Multiplanar Reconstruction ◽  
Source Image ◽  
Bony Defect ◽  
Level Of Evidence ◽  
3 Dimensional ◽  
Bony Bankart ◽  
Glenoid Track

Background: The glenoid track is a useful tool to predict engagement and therefore the risk of recurrence of dislocation in the presence of Hill-Sachs and/or bony Bankart lesions. To assess the glenoid track preoperatively, only methods using 3-dimensional reconstruction (3DR) have been described, but these lack a standardized, reliable, and easy description. Purpose/Hypothesis: The purpose was to evaluate a new method for determining the glenoid track using computed tomography (CT) scan with multiplanar reconstruction (MPR) in comparison with using 3DR images. Our hypothesis was that the MPR method would be easier to standardize and more reproducible. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 52 patients whose arthro-CT scan revealed a Hill-Sachs lesion, whether in combination with a bony Bankart lesion or not, were included. Digital Imaging and Communications in Medicine data from the 52 CT scans were all analyzed using open source image analysis software. Glenoid width, with or without associated bony defect, and the Hill-Sachs interval (HSI) were measured on MPR as well as on 3DR images. All measurements obtained using both methods were directly compared and evaluated for intra- and interobserver reliability. Results: In absolute values, only small differences were seen between the MPR and 3DR methods, amounting to a maximal difference of 0.07 cm for the HSI and 0.04 cm for the glenoid width. For glenoid measurements, both methods were similar. For humeral measurements, the MPR method demonstrated higher inter- and intraobserver reliability than did the 3DR method. Conclusion: The newly described MPR method for the assessment of the glenoid track and HSI is at least as accurate as the published 3DR method, with better intra- and interobserver reliability. Because MPRs are also easier to obtain, this method could be recommended in daily practice.

Robot-assisted percutaneous scaphoid fracture fixation: a report of ten patients

2019 ◽  
Vol 44 (7) ◽  
pp. 685-691 ◽  
Author(s):  
Bo Liu ◽  
Feiran Wu ◽  
Shanlin Chen ◽  
Xieyuan Jiang ◽  
Wei Tian
Keyword(s):  
Scaphoid Fracture ◽  
Three Dimensional ◽  
Contralateral Side ◽  
Level Of Evidence ◽  
Robotic Assisted ◽  
Scaphoid Fractures ◽  
Flexion Extension ◽  
The Mean ◽  
Set Up

This study reports the technique, efficacy and safety of robotic-assisted, computer-navigated, percutaneous fixation of scaphoid fractures. Ten males with acute undisplaced waist fractures underwent fixation with this method using a commercially available three-dimensional fluoroscopy unit and robotic navigation system. The mean total operative duration was 40 minutes, which comprised of a set-up time of 18 minutes and planning and surgical time of 22 minutes. All patients required only a single guidewire insertion attempt, and there were no screw protuberances or other complications. All fractures united at a mean of 8 weeks. At a mean follow-up of 6.5 months (range 6–8), the mean Mayo wrist score was 96, patient-rated wrist evaluation was 2, flexion-extension arc was 96% and grip strength was 91% of the contralateral side. We conclude from our patients that robotic-assisted percutaneous scaphoid fixation is feasible, safe and accurate, and is a satisfactory method for treating these injuries. Level of evidence: IV

scholarly journals Scaphoid Fracture Patterns—Part One: Three-Dimensional Computed Tomography Analysis

2019 ◽  
Vol 08 (06) ◽  
pp. 441-445
Author(s):  
Tessa Drijkoningen ◽  
Amin Mohamadi ◽  
Shai Luria ◽  
Geert A. Buijze
Keyword(s):  
Computed Tomography ◽  
Scaphoid Fracture ◽  
Three Dimensional ◽  
Principal Component ◽  
Fracture Pattern ◽  
Level Of Evidence ◽  
Avulsion Fractures ◽  
Density Mapping ◽  
Scaphoid Fractures ◽  
Fracture Area

Abstract Objective Using three-dimensional (3D) computed tomography models of acute scaphoid fractures, we looked for differences between volumetric size of the fracture fragments, recognizable groups, or a shared common fracture area. Methods We studied 51 patients with an adequate computed tomography scan of an acute scaphoid fracture using 3D modeling. Fracture surfaces were identified and fragment volumetric size of the fracture fragments was measured. A principal component analysis was used to find groups. Density mapping was used to image probable common fracture areas in the scaphoid. Results Forty-nine of 51 fractures had a similar pattern. It was not possible to identify subgroups based on fracture pattern. The mean volumetric size of the fracture fragments of the proximal (1.45 cm3 ± 0.49 cm3 standard deviation [SD]) and distal fracture fragments (1.53 cm3 ± 0.48 cm3 SD) was similar. There was a single common fracture area in the middle third of the bone. In the distal third, there were no horizontal fractures through—but only directly proximal to—the tubercle suggesting that these would be best classified as distal waist fractures. Conclusion Acute scaphoid fractures mainly occur in the middle third of the bone and tend to divide the scaphoid in half by volumetric size of the fracture fragments. There were two distinct grouping patterns: fractures through the proximal and middle third were horizontal oblique, whereas fractures of the distal third were vertical oblique. It seems that scaphoid fractures might be classified into proximal pole fractures, a range of waist fractures, and tubercle avulsion fractures. Level of evidence This is a Level IV study.

scholarly journals Novel Radiographic Indexes for Elbow Stability Assessment: Part B—Preliminary Clinical Study

2021 ◽  
Author(s):  
Francesco Luceri ◽  
Davide Cucchi ◽  
Enrico Rosagrata ◽  
Carlo Eugenio Zaolino ◽  
Alessandra Menon ◽  
...  
Keyword(s):  
Case Series ◽  
Radiographic Evaluation ◽  
Healthy Population ◽  
X Rays ◽  
The Novel ◽  
Level Of Evidence ◽  
Orthopaedic Surgeons ◽  
Joint Congruency ◽  
Radiological Parameters ◽  
The Mean

Abstract Introduction The coronoid process plays a key-role in preserving elbow stability. Currently, there are no radiographic indexes conceived to assess the intrinsic elbow stability and the joint congruency. The aim of this study is to present new radiological parameters, which will help assess the intrinsic stability of the ulnohumeral joint and to define normal values of these indexes in a normal, healthy population. Methods Four independent observers (two orthopaedic surgeons and two radiologists) selected lateral view X-rays of subjects with no history of upper limb disease or surgery. The following radiographic indexes were defined: trochlear depth index (TDI); anterior coverage index (ACI); posterior coverage index (PCI); olecranon–coronoid angle (OCA); radiographic coverage angle (RCA). Inter-observer and intra-observer reproducibility were assessed for each index. Results 126 subjects were included. Standardized lateral elbow radiographs (62 left and 64 right elbows) were obtained and analysed. The mean TDI was 0.46 ± 0.06 (0.3–1.6), the mean ACI was 2.0 ± 0.2 (1.6–3.1) and the mean PCI was 1.3 ± 0.1 (1.0–1.9). The mean RCA was 179.6 ± 8.3° (normalized RCA: 49.9 ± 2.3%) and the mean OCA was 24.6 ± 3.7°. The indexes had a high-grade of inter-observer and intra-observer reliability for each of the four observers. Significantly higher values were found for males for TDI, ACI, PCI and RCA. Conclusion The novel radiological parameters described are simple, reliable and easily reproducible. These features make them a promising tool for radiographic evaluation both for orthopaedic surgeons and for radiologists in the emergency department setting or during outpatient services. Level of evidence Basic Science Study (Case Series). Clinical relevance The novel radiological parameters described are reliable, easily reproducible and become handy for orthopaedic surgeons as well as radiologists in daily clinical practice.

scholarly journals Factors Associated with Scaphoid Nonunion following Early Open Reduction and Internal Fixation

2020 ◽  
Vol 09 (02) ◽  
pp. 141-149
Author(s):  
Pooja Prabhakar ◽  
Lauren Wessel ◽  
Joseph Nguyen ◽  
Jeffrey Stepan ◽  
Michelle Carlson ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Scaphoid Fracture ◽  
Receiver Operating Curve ◽  
Scaphoid Nonunion ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Fracture Location ◽  
Scaphoid Fractures ◽  
Time From Injury

Abstract Background Nonunion after open reduction and internal fixation (ORIF) of scaphoid fractures is reported in 5 to 30% of cases; however, predictors of nonunion are not clearly defined. Objective The purpose of this study is to determine fracture characteristics and surgical factors which may influence progression to nonunion after scaphoid fracture ORIF. Patients and Methods We performed a retrospective case–control study of scaphoid fractures treated by early ORIF between 2003 and 2017. Inclusion criteria were surgical fixation within 6 months from date of injury and postoperative CT with minimum clinical follow-up of 6 months to evaluate healing. Forty-eight patients were included in this study. Nonunion cases were matched by age, sex, and fracture location to patients who progressed to fracture union in the 1:2 ratio. Results This series of 48 patients matched 16 nonunion cases with 32 cases that progressed to union. Fracture location was proximal pole in 15% (7/48) and waist in 85% (41/48). Multivariate regression demonstrated that shorter length of time from injury to initial ORIF and smaller percent of proximal fracture fragment volume were significantly associated with scaphoid nonunion after ORIF (63 vs. 27 days and 34 vs. 40%, respectively). Receiver operating curve analysis revealed that fracture volume below 38% and time from injury to surgery greater than 31 days were associated with nonunion. Conclusion Increased likelihood for nonunion was found when the fracture was treated greater than 31 days from injury and when fracture volume was less than 38% of the entire scaphoid. Level of Evidence This is a Level III, therapeutic study.

scholarly journals Jones Fractures Identified at the National Football League Scouting Combine: Assessment of Prognostic Factors, Computed Tomography Findings, and Initial Career Performance

2018 ◽  
Vol 6 (8) ◽  
pp. 232596711879074 ◽  
Author(s):  
Robert C. Spang ◽  
Daniel B. Haber ◽  
Brendin R. Beaulieu-Jones ◽  
Kristen L. Stupay ◽  
George Sanchez ◽  
...  
Keyword(s):  
Computed Tomography ◽  
National Football League ◽  
Treatment Method ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Specific Performance ◽  
Incomplete Healing ◽  
Bony Healing ◽  
The Mean ◽  
Career Performance

Background: Jones fractures result in subsequent dysfunction and remain an issue for athletes. Purpose: To (1) describe the epidemiology, treatment, and impact of Jones fractures identified at the National Football League (NFL) Scouting Combine on players’ early careers and (2) establish the value of computed tomography (CT) to determine bony healing after a fracture in prospective players. Study Design: Cohort study; Level of evidence, 3. Methods: All players who attended the combine between 2009 and 2015 were retrospectively reviewed to identify their history of Jones fractures. The playing position, treatment method, and number of missed collegiate games were recorded. The mean overall draft pick number, number of games started and played, snap percentage, and position-specific performance scores (fantasy score) over the first 2 years in the NFL were compared between players with fractures and controls. An imaging classification system was applied based on grading of each quadrant of the fifth metatarsal (plantar, dorsal, medial, lateral), with a score of 0 for not healed or 1 for healed. Results: Overall, the number of Jones fractures identified was 72 in 2285 athletes (3.2%), with all treated via intramedullary screw fixation. The mean overall draft pick number for players with fractures was 111.2 ± 67.9 compared with 99.0 ± 65.9 for controls ( P = .12). Performance scores for players with fractures were lower than those for controls across all positions, with a significant difference in running backs (2.6 vs 4.0, respectively; P < .001) and defensive linemen (1.4 vs 2.3, respectively; P = .02). The mean CT score was 2.5 ± 1.3. Of the 32 athletes who underwent imaging, 16 Jones fractures (50.0%) were healed or nearly healed, 12 (37.5%) were partially healed, and 4 (12.5%) showed little or no healing. The plantar cortex demonstrated the least healing (18/32; 56.3%), followed by the lateral cortex (15/32; 46.9%). Players with a mean score <1 were found to have fewer games started (2.7 ± 2.5) than those with 1 to 3 cortices healed (17.4 ± 10.4) or all cortices healed (8.7 ± 11.2). Conclusion: Based on CT, 50% of all players with a previous Jones fracture demonstrated incomplete healing. Moreover, position-specific performance scores over the first 2 years of a player’s career were lower across all positions for those with fractures compared with controls. Players with CT scores <1 were found to start fewer games and were drafted later than controls.

scholarly journals Reduction and Association of the Scaphoid and Lunate: A Functional and Radiographical Outcome Study

2018 ◽  
Vol 08 (01) ◽  
pp. 037-042
Author(s):  
William Aibinder ◽  
Ali Izadpanah ◽  
Bassem Elhassan
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
High Rate ◽  
Salvage Procedure ◽  
Level Of Evidence ◽  
Long Term Follow Up ◽  
The Mean ◽  
Ligament Disruption

Background Management of scapholunate (SL) ligament disruption is a challenging problem. The reduction and association of the scaphoid and lunate (RASL) procedure has been described with varying results. This study assessed the outcomes of the RASL procedure. Purpose The objective of this study was to assess the outcomes of patients undergoing the RASL procedure at our institution in regard to pain relief, range of motion, radiographic and functional outcomes, complications, and reoperations. Materials and Methods Twelve patients with symptomatic chronic SL instability underwent the RASL procedure. The mean age was 35 years. The mean time from injury to surgery was 40 weeks. The mean follow-up was 89 months. Outcomes included visual analog score for pain, wrist range of motion, grip strength, and Mayo Wrist Scores. Preoperative and postoperative radiographs were reviewed. Results Pain scores improved in 10 wrists. Range of motion and grip strength worsened. The average Mayo Wrist Score was 63.3. The mean SL diastasis and angle improved, but seven wrists developed progressive degenerative changes, with two requiring a salvage procedure. Symptomatic progressive screw lucency occurred in eight wrists requiring screw removal. Conclusion The RASL procedure can improve SL widening but has a high rate of early failure and reoperation. Following reoperation, long-term follow-up demonstrates reasonable long-term durability in some cases. Level of Evidence This is a Level IV, therapeutic case study.

3D Biometrics for Hindfoot Alignment Using Weightbearing Computed Tomography

2019 ◽  
Vol 40 (6) ◽  
pp. 720-726 ◽  
Author(s):  
Jian Zhong Zhang ◽  
François Lintz ◽  
Alessio Bernasconi ◽  
Shu Zhang ◽  
Keyword(s):  
Computed Tomography ◽  
Comparative Study ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Level Of Evidence ◽  
Hindfoot Alignment ◽  
Mean Values ◽  
Intraclass Correlation Coefficients ◽  
Prospective Comparative Study

Background: Weightbearing computed tomography (WBCT) is a useful tool for the assessment of hindfoot alignment (HA). Foot ankle offset (FAO) is a recently introduced parameter, determined from WBCT images using semiautomatic software. The aim of this study was to determine the clinical relevance and reproducibility of FAO for the evaluation of HA. Methods: A prospective comparative study was performed on consecutive patients requiring bilateral WBCT between September 2017 and April 2018. Based on the clinical assessment of HA, patients were divided into 3 groups: (1) normal alignment group (G1), (2) valgus (G2), and (3) varus (G3). FAO and long axial view (HACT) were measured on WBCT images, and the groups were compared. The reproducibility of FAO and HACT was determined through intraclass correlation coefficients (ICCs). Regression analysis was performed to investigate the correlation between the 2 methods. Overall, 249 feet (126 patients) were included (G1 = 115, G2 = 78, and G3 = 56 feet). Results: The mean values for FAO and HACT were 1.2% ± 2.8% and 3.9 ± 3.1, respectively, in G1; 8.1% ± 3.7% and 9.7 ± 4.9 in G2; and −6.6% ± 4.8% and −8.2 ± 6.6 in G3. Intra- and interobserver reliability was 0.987 and 0.988 for FAO and 0.949 and 0.949 for HACT, respectively. There was a good linear correlation between HACT and FAO ( R2 = 0.744), with a regression slope of 1.064. Conclusions: WBCT was a useful method for the characterization of HA. FAO was reproducible and correlated well with physical examination. Level of Evidence: Level II, prospective comparative study.

Reliability of clinical tests for prediction of occult scaphoid fractures and cost benefit analysis of a dedicated scaphoid pathway

2020 ◽  
pp. 175319342097946
Author(s):  
Preetham Kodumuri ◽  
Andrew McDonough ◽  
Victoria Lyle ◽  
Zaf Naqui ◽  
Lindsay Muir
Keyword(s):  
Outcome Measure ◽  
Cost Benefit Analysis ◽  
Scaphoid Fracture ◽  
Cost Benefit ◽  
Clinical Suspicion ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Post Injury ◽  
Level Of Evidence ◽  
Scaphoid Fractures

We reviewed the outcomes of our dedicated clinic for suspected scaphoid fractures. The primary outcome measure was to test the reliability of accurately diagnosing an occult scaphoid fracture with a combination of anatomical snuff box, scaphoid tubercle, longitudinal compression tenderness, ulnar deviation and the pinch test. Cost savings of the new patient pathway was our secondary outcome measure. Between December 2016 and March 2020, 922 patients were recruited at a mean of 12 days post-injury. Sixty-five per cent ( n = 602) with a low clinical suspicion were discharged and 35% ( n = 320) with a high clinical suspicion had same day MRI scan. Fifty-eight scaphoid fractures were diagnosed and treated with no nonunions reported. Anatomical snuff box tenderness was the most sensitive test (90%). A combination of five tests better excluded an occult fracture (80% accuracy). The dedicated scaphoid clinic pathway resulted in 350 fewer follow-up visits and an overall saving of £59,666. Level of evidence: III

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