scholarly journals Suspected scaphoid injuries managed by MRI direct from the emergency department

2021 ◽  
Vol 2 (6) ◽  
pp. 447-453
Author(s):  
Benjamin J. F. Dean ◽  
Christopher Little ◽  
Nicholas D. Riley ◽  
Edward Sellon ◽  
Warren Sheehan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Scaphoid Fracture ◽  
Clinical Signs ◽  
Early Discharge ◽  
Median Number ◽  
Service Evaluation ◽  
Delayed Union ◽  
Cast Immobilization ◽  
Wrist Trauma ◽  
Scaphoid Fractures

Aims To determine the role of early MRI in the management of suspected scaphoid fractures. Methods A total of 337 consecutive patients presenting to an emergency department (ED) following wrist trauma over a 12-month period were prospectively included in this service evaluation project. MRI was not required in 62 patients with clear diagnoses, and 17 patients were not managed as per pathway, leaving a total of 258 patients with normal scaphoid series radiographs who were then referred directly from ED for an acute wrist MRI scan. Patient demographics, clinical details, outcomes, and complications were recorded at a minimum of a year following injury. Results The median time from injury to ED presentation was one day and the median number of positive clinical signs was two out of three (snuffbox tenderness, tubercle tenderness, pain on telescoping). Of 258 patients referred for acute MRI, 208 scans were performed as 50 patients either did not tolerate (five patients) or did not attend their scan (45 patients). MRI scans demonstrated scaphoid fracture (13%), fracture of another bone (22%), scaphoid contusion (6%), other contusion/ligamentous injury (20%), or solely degenerative pathology (10%). Only 29% of scans showed no abnormality. Almost 50% of those undergoing MRI (100 patients) were discharged by ED with advice, with only one re-presentation. Of the 27 undisplaced occult scaphoid fractures, despite prompt cast immobilization, two experienced delayed union which was successfully treated with surgery. Conclusion The use of MRI direct from ED enables prompt diagnosis and the early discharge of a large proportion of patients with normal radiographs following wrist trauma. Cite this article: Bone Jt Open 2021;2(6):447–453.

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.

scholarly journals 451 Children’s emergency department review clinic: what we have learnt in the covid-19 pandemic

2020 ◽  
Vol 37 (12) ◽  
pp. 852.1-852
Author(s):  
Charlotte Munday ◽  
Neha Jain ◽  
Seamus Harrington ◽  
Benjamin Darvill ◽  
Sophie Perry ◽  
...  
Keyword(s):  
Emergency Department ◽  
Scaphoid Fracture ◽  
Cost Effective ◽  
Orbital Cellulitis ◽  
Royal Hospital ◽  
Face To Face ◽  
Paediatric Emergency ◽  
Scaphoid Fractures ◽  
Patient Pathways ◽  
At Home

Aims/Objectives/BackgroundThe Children’s Emergency Department (CED) in the Bristol Royal Hospital for Children (BRHC) runs ‘Review Clinics’ by a Paediatric Emergency Consultant. These were suspended in March 2020 due to the Covid-19 pandemic and new patient pathways were put in place. Our aim was to assess the effectiveness of these pathways and to evaluate if they should continue once the pressures of Covid-19 have eased.Methods/DesignWe reviewed all the attendances to the ED Review Clinic over a six-week period in 2019 and identified common conditions that are seen in this clinic – abscesses, cellulitis, scaphoid fracture, toddler fracture, limp, headache, peri-orbital cellulitis, torticollis, and neck lumps (accounting for 66% of all attendances).We then identified all of the ED attendances with these conditions over the same six-week period during the Covid-19 pandemic and performed a service review using medical notes.Results/ConclusionsAll children presenting with a limp during the Covid-19 pandemic were discharged with a leaflet and advised to return in one week if the limp persisted. None of them re-attended.Scaphoid and toddler fractures that presented during the Covid-19 pandemic were followed-up by Orthopaedics with a combination of telephone and face-to-face reviews. The toddler fractures were put into soft casts to be removed at home - 93% of parents were happy to do this. Orthopaedic review was quicker than the previous ED Review Clinic (an average of 63 hours compared to 216 for scaphoid fractures and 67 hours compared to 235 for toddler fractures).The results suggest that ED Review Clinics can and should change. Children with a limp can be sent home safely with clear advice. There is a greater role for telephone reviews, in particular, for injuries such as toddler fractures. This would be quicker, less time-consuming for patients, parents and physicians and more cost effective for the department.

Cost-effectiveness of MRI in managing suspected scaphoid fractures

2009 ◽  
Vol 34 (5) ◽  
pp. 627-630 ◽  
Author(s):  
T. B. HANSEN ◽  
R. B. PETERSEN ◽  
J. BARCKMAN ◽  
P. UHRE ◽  
K. LARSEN
Keyword(s):  
Cost Effectiveness ◽  
Sick Leave ◽  
Scaphoid Fracture ◽  
Treatment Algorithm ◽  
Hospital Costs ◽  
Clinical Signs ◽  
Cost Effective ◽  
Effectiveness Study ◽  
Scaphoid Fractures ◽  
Cost Effectiveness Study

In a cost-effectiveness study, we compared a treatment algorithm using repeated radiological examination with an algorithm using subacute MRI in patients with clinical signs of scaphoid fracture but normal initial radiography. Twenty-seven patients were included in both groups, and MRI reduced the immobilisation time from 20 days (range, 6–54) to 4 days (range, 1–19) and sick leave from 27 days (1–92) to 11 days (0–28). Use of MRI increased hospital costs by €151 ( P<0.05), but reduced non-hospital costs by €2869 ( P<0.05), making MRI cost-effective in the treatment of suspected scaphoid fractures.

Operative Treatment of Acute Scaphoid Fractures

Hand Surgery ◽  
2015 ◽  
Vol 20 (02) ◽  
pp. 210-214 ◽  
Author(s):  
Lana Kang
Keyword(s):  
Operative Treatment ◽  
Scaphoid Fracture ◽  
Delayed Union ◽  
Carpal Bone ◽  
Non Union ◽  
Inherent Risk ◽  
Scaphoid Fractures ◽  
Appropriate Treatment ◽  
Missed Diagnosis ◽  
Challenging Situation

Optimal treatment of acute scaphoid fractures is a necessary goal for many reasons. One is that the scaphoid is the most commonly fractured carpal bone. Another is that a missed diagnosis of an acute scaphoid fracture leads to the more challenging situation of a delayed union, non-union and risk for premature radiocarpal arthrosis. Because the scaphoid has an inherent risk for nonunion due to its the tenuous blood supply, timely diagnosis and appropriate treatment are considered critical to achieving acceptable results and to avoiding the consequences of failed union.

scholarly journals Fractures of the scaphoid, diagnosis and managementa review

2013 ◽  
Vol 60 (2) ◽  
pp. 99-102 ◽  
Author(s):  
Sladjana Andjelkovic ◽  
Cedo Vuckovic ◽  
Aleksandar Lesic ◽  
Goran Tulic ◽  
Suzana Milutinovic ◽  
...  
Keyword(s):  
Scaphoid Fracture ◽  
Delayed Union ◽  
Adverse Outcomes ◽  
Scaphoid Bone ◽  
Wrist Injuries ◽  
Delay In Diagnosis ◽  
Scaphoid Fractures ◽  
Radiocarpal Joint ◽  
High Index Of Suspicion ◽  
Loss Of Motion

The scaphoid is vitally important for the proper mechanics of wrist function. Fracture of the scaphoid bone is the most common carpal fracture. Among all wrist injuries the incidence of scaphoid fracture is second only to fractures of the distal radius. Scaphoid fractures are significant because a delay in diagnosis can lead to a variety of adverse outcomes that include nonunion, delayed union, decreased grips strength, range of motion and osteoarthritis of the radiocarpal joint. To avoid missing this diagnosis, a high index of suspicion and a through history and physical examination are necessary, because initial radiographs are often negative. Regardless of the technique of bone grafting, there will almost always be some loss of motion even if the fracture unites.

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

Clinical Signs in Scaphoid Fractures

1994 ◽  
Vol 19 (6) ◽  
pp. 743-747 ◽  
Author(s):  
M. WAIZENEGGER ◽  
N. J. BARTON ◽  
T. R. C. DAVIS ◽  
M. L. WASTIE
Keyword(s):  
Prospective Study ◽  
Clinical Features ◽  
Scaphoid Fracture ◽  
Clinical Signs ◽  
Scaphoid Fractures ◽  
A Prospective Study

In a prospective study we investigated 12 clinical features for scaphoid fractures in 52 patients: 23 in whom a fracture of the scaphoid was diagnosed radiologically and 29 patients in whom a fracture was clinically suspected but could not be confirmed by radiography or scintigraphy. The signs were tested within a few days of injury and again 2 weeks later. None was reliable in diagnosing a scaphoid fracture.

Combining the Clinical Signs Improves Diagnosis of Scaphoid Fractures

1998 ◽  
Vol 23 (3) ◽  
pp. 324-327 ◽  
Author(s):  
J. PARVIZI ◽  
J. WAYMAN ◽  
P. KELLY ◽  
C. G. MORAN
Keyword(s):  
Prospective Study ◽  
Clinical Diagnosis ◽  
Scaphoid Fracture ◽  
Clinical Signs ◽  
Initial Examination ◽  
Longitudinal Compression ◽  
Scaphoid Fractures ◽  
Thumb Movement ◽  
A Prospective Study ◽  
Suspected Scaphoid Fracture

This is a prospective study evaluating the efficacy of four clinical signs believed to be useful in the diagnosis of scaphoid fracture. Two hundred and fifteen consecutive patients with suspected scaphoid fracture were examined on two separate occasions to evaluate tenderness in the anatomical snuff box (ASB), tenderness over the scaphoid tuberele (ST), pain on longitudinal compression of the thumb (LC) and the range of thumb movement (TM). At the initial examination ASB, ST and LC were all 100% sensitive for detecting scaphoid fracture with specificities of 9%, 30% and 48% respectively. These clinical signs used in combination, within the first 24 hours following injury, produced 100% sensitivity and an improvement in the specificity to 74%. TM had 69% sensitivity and 66% specificity. Our results suggest that these clinical signs are inadequate indicators of scaphoid fracture when used alone and should be combined to achieve a more accurate clinical diagnosis.

Management and Outcomes of Clinical Scaphoid Fractures in Children

Hand ◽  
2020 ◽  
pp. 155894472093029
Author(s):  
Aneesh Karir ◽  
Minh N. Q. Huynh ◽  
Sasha Carsen ◽  
Kevin Smit ◽  
Kevin Cheung
Keyword(s):  
Scaphoid Fracture ◽  
Clinical Signs ◽  
Fracture Rate ◽  
X Rays ◽  
Advanced Imaging ◽  
Scaphoid Fractures ◽  
Fractures In Children ◽  
Magnetic Resonance Imaging Mri ◽  
Mean Time ◽  
Pediatric Center

Background: Acute wrist trauma with clinical suspicion of a scaphoid fracture, but normal radiographs, is known as a clinical scaphoid fracture. Standard treatment involves immobilization and repeat radiographs in 10 to 14 days. When repeat radiographs are normal but a scaphoid fracture is still clinically suspected, the optimal management in children is unknown. This study retrospectively assessed the management and outcomes of pediatric patients diagnosed with clinical scaphoid fractures. Methods: A retrospective study was performed of all patients over a 2-year period treated for a clinical scaphoid fracture at a tertiary pediatric center. Patients were included if they had clinical signs of a scaphoid fracture and 2 negative x-rays 7 to 14 days apart postinjury. Results: Ninety-one patients with a mean age of 13.2 years (range: 7.8-17.7) were included. Sixteen patients (17.6%) underwent computed tomography (CT) or magnetic resonance imaging (MRI) at a mean time of 10.2 weeks postinjury. Five patients (5.5%) were diagnosed with a scaphoid fracture by x-ray or CT at an average of 4.5 weeks postinjury (range: 3-6). Six patients were diagnosed with other wrist fractures at a mean time postinjury of 3.1 (range: 3-6.5) weeks. Out of 195 total radiographs, the surgeon and radiologist disagreed on 59 (30.2%) images. No patients underwent surgery. Conclusions: Management of clinical scaphoid fractures at our institution was relatively uniform: nearly all patients were immobilized and less than 20% received advanced imaging. Our findings suggest a low but non-zero occult scaphoid fracture rate, discordance in radiologic interpretation, and lack of advanced imaging, providing an avenue for future prospective studies.

scholarly journals Conservative treatment of scaphoid fracture: Protocol for a systematic review

2022 ◽  
Vol 11 (1) ◽  
pp. e43611125220
Author(s):  
Taís Ribeiro Sousa Oliveira da Cunha ◽  
Matheus Velame de Morais ◽  
Larrie Rabelo Laporte ◽  
Cloud Kennedy Couto de Sá ◽  
Alex Guedes ◽  
...  
Keyword(s):  
Systematic Review ◽  
Social Impact ◽  
Bone Fractures ◽  
Scaphoid Fracture ◽  
Plaster Cast ◽  
Carpal Bone ◽  
Cast Immobilization ◽  
Secondary Osteoarthritis ◽  
Scaphoid Fractures ◽  
Carpal Bone Fractures

The scaphoid is the most commonly fractured carpal bone. Fractures affecting this bone affect young and active patients between 15 and 40 years of age. Stable scaphoid fractures are treated conservatively by plaster cast immobilization or other type of orthosis for an average period of four to 12 weeks. Failure to treat scaphoid fractures may result in avascular necrosis, nonunion, and early secondary osteoarthritis, which may result in significant economic and social impact due to the affected population, formed by young people of productive age. The management of this type of fracture varies significantly between different Institutions and orthopedic surgeons. This article describes a protocol for a systematic review that aims to evaluate the effects (benefits and harms) of conservative interventions in the treatment of scaphoid fractures in adults.

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