Management of acute scaphoid fractures: a pragmatic approach for the non-specialist

2021 ◽  
pp. 1-7
Author(s):  
Saif A Ansari ◽  
John T Hirst ◽  
Fizan Younis
Keyword(s):  
Conservative Management ◽  
Scaphoid Fracture ◽  
Orthopaedic Surgeon ◽  
Initial Assessment ◽  
Significant Morbidity ◽  
Pragmatic Approach ◽  
Scaphoid Fractures ◽  
Management Plans ◽  
Vascular Compromise

Scaphoid fractures are common and can cause significant morbidity if treated incorrectly. Thus, a working knowledge of the initial assessment and management of scaphoid fractures by non-specialists is crucial to allow quick diagnosis and avoid potentially catastrophic complications of scaphoid fracture. This article summarises the anatomy of the scaphoid, discusses methods to assess for scaphoid fractures and delineates management plans (conservative or operative) for fractures of the scaphoid based on location of vascular compromise. This article can also help the clinician predict which fractures may not unite with conservative management and therefore need referral to a specialist orthopaedic surgeon for possible surgery.

scholarly journals Acute scaphoid fractures: guidelines for diagnosis and treatment

2020 ◽  
Vol 5 (2) ◽  
pp. 96-103 ◽  
Author(s):  
Martin Clementson ◽  
Anders Björkman ◽  
Niels O. B. Thomsen
Keyword(s):  
Internal Fixation ◽  
Fracture Healing ◽  
Conservative Management ◽  
Scaphoid Fracture ◽  
Longitudinal Axis ◽  
Fracture Type ◽  
Fracture Classification ◽  
Cast Immobilization ◽  
Scaphoid Fractures ◽  
Suspected Scaphoid Fracture

In cases of suspected scaphoid fracture where the initial radiographs are negative, a supplementary MRI, or alternatively CT, should be carried out within three to five days. Fracture classification, assessment of dislocation as well as evaluation of fracture healing is best done on CT with reconstructions in the coronal and sagittal planes, following the longitudinal axis of the scaphoid. After adequate conservative management, union is achieved at six weeks for approximately 90% of non-displaced or minimally displaced (≤ 0.5 mm) scaphoid waist fractures. Scaphoid waist fractures with moderate displacement (0.5–1.5 mm) can be treated conservatively, but require prolonged cast immobilization for approximately eight to ten weeks. Internal fixation is recommended for all scaphoid waist fractures with dislocation ≥ 1.5 mm. Distal scaphoid fractures can be treated conservatively. The majority heal uneventfully after four to six weeks of immobilization, depending on fracture type. In general, proximal scaphoid fractures should be treated with internal fixation. Cite this article: EFORT Open Rev 2020;5:96-103. DOI: 10.1302/2058-5241.5.190025

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 COMPARISON OF OPERATIVE FIXATION OF ACUTE SCAPHOID FRACTURES WITH THE NON-OPERATIVE TREATMENT: A PROSPECTIVE CLINICAL STUDY.

2020 ◽  
Vol 4 (4) ◽  
Author(s):  
Kanhaiya Lal Gupta
Keyword(s):  
Clinical Study ◽  
Operative Treatment ◽  
Scaphoid Fracture ◽  
Joint Stiffness ◽  
Prospective Clinical Study ◽  
Left Hand ◽  
Scaphoid Fractures ◽  
Common Location ◽  
Operative Fixation ◽  
Group B

Aim: to compare the results of operative fixation of acute scaphoid fractures with those of non-operative treatment. Materials & Method: This clinical study was carried out among 26 patients with an acute nondisplaced or minimally displaced scaphoid fracture reported to the OPD of Orthopedics, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India. Patients were non-randomly allocated to group A (non-operative treatment with a cast) and group B (internal fixation with a Herbert screw). Results: mean age of the study population was 41.23 years. Majority of them were male 21 (80.7%) and rest 5 (19.3%) were female. Out of total 26 scaphoid fracture cases 16 (61.5%) were of right hand and rest 10 (38.5%) found on the left hand. Most common location of fracture was waist fracture (B2) 10 cases. 100% union was observed in group B. Conclusions: study proves that Cast treatment has the disadvantages of longer immobilisation time, joint stiffness, reduced grip strength, and longer time to return to work whereas the operative fixation of acute scaphoid fractures results in predictable satisfactory union rate and good functional outcome. Keywords: cast treatment, scaphoid fracture

scholarly journals Diagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review update.

2019 ◽  
Author(s):  
Patrick Krastman ◽  
Nina M. Mathijssen ◽  
Sita M.A. Bierma-Zeinstra ◽  
Gerald Kraan ◽  
Jos Runhaar
Keyword(s):  
Physical Examination ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Scaphoid Fracture ◽  
Radiological Examination ◽  
Supporting Evidence ◽  
History Taking ◽  
Wrist Fractures ◽  
Scaphoid Fractures ◽  
Work Up

Abstract Background The standard diagnostic work-up for hand and wrist fractures consists of history taking, physical examination and imaging if needed, but the supporting evidence for this work-up is limited. The purpose of this study was to systematically examine the diagnostic accuracy of tests for hand and wrist fractures. Methods A systematic search for relevant studies was performed. Methodological quality was assessed and sensitivity (Se), specificity (Sp), accuracy, positive predictive value (PPV) and negative predictive value (NPV) were extracted from the eligible studies. Results Of the 35 eligible studies, one described the diagnostic accuracy of history taking for hand and wrist fractures. Physical examination with or without radiological examination for diagnosing scaphoid fractures (five studies) showed Se, Sp, accuracy, PPV and NPV ranging from 15-100%, 13-98%, 55-73%, 14-73% and 75-100%, respectively. Physical examination with radiological examination for diagnosing other carpal bone fractures (one study) showed a Se of 100%, with the exception of the triquetrum (75%). Physical examination for diagnosing phalangeal and metacarpal fractures (one study) showed Se, Sp, accuracy, PPV and NPV ranging from 26-55%, 13-89%, 45-76%, 41-77% and 63-75%, respectively. Imaging modalities of scaphoid fractures showed predominantly low values for PPV and the highest values for Sp and NPV (24 studies). Magnetic Resonance Imaging (MRI), Computed Tomography (CT), Ultrasonography (US) and Bone Scintigraphy (BS) were comparable in diagnostic accuracy for diagnosing a scaphoid fracture, with an accuracy ranging from 85-100%, 79-100%, 49-100% and 86-97%, respectively. Imaging for metacarpal and finger fractures showed Se, Sp, accuracy, PPV and NPV ranging from 73-100%, 78-100%, 70-100%, 79-100% and 70-100%, respectively. Conclusions Only one study was found on the diagnostic accuracy of history taking for hand and wrist fractures in the current review. Physical examination was of moderate use for diagnosing a scaphoid fracture and of limited use for diagnosing phalangeal, metacarpal and remaining carpal fractures. MRI, CT and BS were found to be moderately accurate for the definitive diagnosis of clinically suspected carpal fractures.

scholarly journals Ruptures of mesentery- a silent posttraumatic injury (Case Report)

2020 ◽  
Vol 3 (2) ◽  
pp. 81-89
Author(s):  
Irina-Anca Eremia ◽  
Leonard Grecescu ◽  
Siegfried Albu ◽  
Adela Iancu ◽  
Remus Nica ◽  
...  
Keyword(s):  
Case Report ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Bowel Wall ◽  
Scaphoid Fracture ◽  
Vascular Supply ◽  
Initial Assessment ◽  
Polytraumatized Patient ◽  
Mesenteric Injury ◽  
Rare Lesion

AbstractThe mechanism of mesenteric injury in blunt abdominal trauma involves compression and deceleration forces which result in a spectrum of injuries that range from contusions to tearing of the bowel wall, tearing of the mesentery, and loss of vascular supply. Hemoperitoneum is a major sign of severity in abdominal trauma, which, in most cases, requires emergency surgery.Our patient showed that the diagnosis of mesenteric injury should be considered even in patients who sustain only minor abdominal trauma. In this case the patient’s symptoms were suggestive only for the orthopedic lesion and not for the hemoperitoneum.Trans-scapho-lunate dislocation fracture is a rare lesion that may go unnoticed at initial assessment in a polytraumatized patient. A delay in the diagnosis and treatment of a scaphoid fracture may alter the prognosis after consolidation.

1301 Early MRI in the Diagnosis of Suspected Scaphoid Fractures – An Audit of a Redesigned Diagnostic Pathway

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
J Cullen ◽  
R Donovan ◽  
K Vipulendran ◽  
E Lostis ◽  
N Blewitt ◽  
...  
Keyword(s):  
Scaphoid Fracture ◽  
Degenerative Change ◽  
Clinic Visit ◽  
Bone Bruise ◽  
X Rays ◽  
Scaphoid Fractures ◽  
Time Period ◽  
Audit Reports ◽  
The Impact ◽  
Limited Sequence

Abstract Introduction MRI is the gold standard for investigation of suspected scaphoid fractures, which can be missed on initial x-rays. This full cycle audit reports the impact of our new patient pathway, which changes repeat x-rays at 2 weeks to urgent limited sequence scaphoid MRI for those with normal initial x-rays, but clinical suspicion of fracture at initial clinic visit. Method A second cycle audited MRI requests for suspected scaphoid fractures at Southmead hospital following implementation of the new pathway in October 2020. We collected wait times from request to scan, and radiologist reports. Results were compared to our first cycle, 6-month time period. Results he results for 24 limited sequence MRIs via our new pathway were compared to 134 full wrist MRIs of the first cycle. Two scans (9.1%) were positive for scaphoid fracture versus 12% in the first cycle. 19 scans (86%) identified alternate pathology including sprain (6), bone bruise (5), non-scaphoid fractures (4) and degenerative change (3). 1 scan (4.5%) was reported as normal. 73% of MRIs were performed within 14 days, compared to 63% in previous cohort. Conclusions Our new pathway using limited sequence MRI identified similar rates of scaphoid fractures. Reduced time to MRI was observed compared to the previous cohort due to shorter scan durations and resulted in earlier diagnosis and fewer outpatient follow-up appointments. Our new pathway has benefits to patient experience and also reduces footfall in hospital, during a time of global Covid-19 pandemic, with no increase in costs.

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

scholarly journals Diagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review update

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Patrick Krastman ◽  
Nina M. Mathijssen ◽  
Sita M. A. Bierma-Zeinstra ◽  
Gerald Kraan ◽  
Jos Runhaar
Keyword(s):  
Physical Examination ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Scaphoid Fracture ◽  
Radiological Examination ◽  
Supporting Evidence ◽  
History Taking ◽  
Wrist Fractures ◽  
Scaphoid Fractures ◽  
Work Up

Abstract Background The standard diagnostic work-up for hand and wrist fractures consists of history taking, physical examination and imaging if needed, but the supporting evidence for this work-up is limited. The purpose of this study was to systematically examine the diagnostic accuracy of tests for hand and wrist fractures. Methods A systematic search for relevant studies was performed. Methodological quality was assessed and sensitivity (Se), specificity (Sp), accuracy, positive predictive value (PPV) and negative predictive value (NPV) were extracted from the eligible studies. Results Of the 35 eligible studies, two described the diagnostic accuracy of history taking for hand and wrist fractures. Physical examination with or without radiological examination for diagnosing scaphoid fractures (five studies) showed Se, Sp, accuracy, PPV and NPV ranging from 15 to 100%, 13–98%, 55–73%, 14–73% and 75–100%, respectively. Physical examination with radiological examination for diagnosing other carpal bone fractures (one study) showed a Se of 100%, with the exception of the triquetrum (75%). Physical examination for diagnosing phalangeal and metacarpal fractures (one study) showed Se, Sp, accuracy, PPV and NPV ranging from 26 to 55%, 13–89%, 45–76%, 41–77% and 63–75%, respectively. Imaging modalities of scaphoid fractures showed predominantly low values for PPV and the highest values for Sp and NPV (24 studies). Magnetic Resonance Imaging (MRI), Computed Tomography (CT), Ultrasonography (US) and Bone Scintigraphy (BS) were comparable in diagnostic accuracy for diagnosing a scaphoid fracture, with an accuracy ranging from 85 to 100%, 79–100%, 49–100% and 86–97%, respectively. Imaging for metacarpal and finger fractures showed Se, Sp, accuracy, PPV and NPV ranging from 73 to 100%, 78–100%, 70–100%, 79–100% and 70–100%, respectively. Conclusions Only two studies were found on the diagnostic accuracy of history taking for hand and wrist fractures in the current review. Physical examination was of moderate use for diagnosing a scaphoid fracture and of limited use for diagnosing phalangeal, metacarpal and remaining carpal fractures. MRI, CT and BS were found to be moderately accurate for the definitive diagnosis of clinically suspected carpal fractures.

Association of Lunate Morphology With Progression to Scaphoid Fracture Nonunion

Hand ◽  
2020 ◽  
pp. 155894472093736
Author(s):  
Rachel E. Hein ◽  
Amanda N. Fletcher ◽  
Rose T. Tillis ◽  
Eric Q. Pang ◽  
David S. Ruch ◽  
...  
Keyword(s):  
Scaphoid Fracture ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Delayed Union ◽  
Type I ◽  
Type Ii ◽  
Fracture Location ◽  
Scaphoid Fractures ◽  
Fracture Nonunion ◽  
N 93

Background: The purpose of our study was to review a series of patients with scaphoid fractures to determine whether there was an association between lunate morphology and progression to delayed union or nonunion when treated operatively or nonoperatively. Secondary aims included evaluation of the relationship between lunate morphology and scaphoid fracture location. Methods: A retrospective review of all patients with a diagnosis of scaphoid fracture was performed at our institution between 2014 and 2017. Medical records and radiographs were evaluated to determine lunate morphology, scaphoid fracture location, treatment, and time to union. Differences between groups were determined using χ2 analysis with significance set at P <.05. Multiple logistic regression analyses were used to evaluate scaphoid union in the setting of lunate morphology when controlling for confounders. Results: A total of 169 patients were included; 45.0% (n = 76) of patients had type I lunate morphology, and 55.0% (n = 93) had type II. In all, 64.5% (n = 49) of patients with type I lunate and 68.8% (n = 64) with type II lunate had a fracture at the scaphoid waist. Among all patients with a scaphoid fracture, type II lunates were more likely than type I lunates to progress to nonunion when treated both operatively and nonoperatively (18.3% vs 4.0%, P = .0042). Lunate facet size was not shown to be a significant risk factor for nonunion among patients with a type II lunate ( P = .4221). Conclusions: Patients with a scaphoid fracture and type II lunate morphology were more likely to progress to nonunion than patients with a type I lunate.

The Scaphoid Fat Stripe in the Diagnosis of Carpal Trauma

1988 ◽  
Vol 29 (1) ◽  
pp. 97-99 ◽  
Author(s):  
J. Langer Andersen ◽  
P. Grøn ◽  
O. Langhoff
Keyword(s):  
Differential Diagnosis ◽  
Sick Leave ◽  
Retrospective Analysis ◽  
Scaphoid Fracture ◽  
Radiographic Examination ◽  
Plaster Of Paris ◽  
Scaphoid Fractures ◽  
Carpal Trauma ◽  
Reduction Of Costs

During a ten-year period scaphoid fracture was suggested in 541 wrists, but in 283 cases could not be confirmed at the initial radiographic examination. These cases were immobilized in plaster of Paris and examined clinically and radiologically 10 to 14 days later. A total of 274 additional radiographic examinations revealed 32 scaphoid fractures not initially recognized. Two fractures were at the retrospective analysis found to have been neglected. In the 249 cases where a fracture was never demonstrated, the immobilization and resulting sick leave were in retrospect considered not to have been indicated. In a retrospective analysis of case records and radiographic material including the configuration of the scaphoid fat stripe (SFS) at the initial radiographic examination the SFS was found to be useful in diagnosing scaphoid fractures. The use of the SFS in differential diagnosis would result in reduction of costs and inconvenience for patients without scaphoid fracture.

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