Diagnosis and Treatment of Scaphoid Waist Fractures: A Literature Review

2020 ◽  
Author(s):  
Mohammad Ali Okhovatpour ◽  
Adel Ebrahimpour ◽  
Mohammadreza Minator Sajjadi ◽  
Mehrdad Sadighi ◽  
Reza Zandi ◽  
...  
Keyword(s):  
Ct Scan ◽  
Scaphoid Fracture ◽  
Diagnosis And Treatment ◽  
Wrist Flexion ◽  
Work Time ◽  
Scaphoid Fractures ◽  
Magnetic Resonance Imaging Mri ◽  
Nondisplaced Fracture ◽  
Tomography Scan

Scaphoid fracture can cause serious complications and its diagnosis and treatment approaches are still contentious. Tenderness of anatomical snuffbox (ASB), longitudinal compression (LC) of the thumb, and scaphoid tubercle (ST) tenderness are very sensitive tests for clinical diagnosis of scaphoid factures all together. Previous studies recommend taking four standard views of the wrist for non-displaced scaphoid fractures diagnosis. Magnetic resonance imaging (MRI), computed tomography scan (CT scan), bone scintigraphy, and ultrasound are used for triage of suspected scaphoid fractures. MRI has the highest sensitivity and specificity. CT scan images captured in planes by the long axis of the scaphoid guide the diagnosis of nondisplaced scaphoid fracture. Displaced fractures need surgical treatment, but the best way of treating a nondisplaced fracture is controversial. Same results have been determined using a short arm or long arm cast for treatment of nondisplaced scaphoid fractures as well as similar outcomes with or without a thumb-spica component to the cast. Wrist position immobilization did not affect the rate of nonunion, wrist flexion, pain, or grip strength. Percutaneous screw fixation can shorten return to work time. CT scan and MRI both can be applied for assessment of union of fracture during follow-up period. This study aims to review the literature on challenges about clinical and radiologic diagnosis of nondisplaced scaphoid fractures and also present concepts about definite management of nondisplaced and minimally-displaced scaphoid waist fractures.

scholarly journals Interpretasi Hasil Pemeriksaan MRI Kardiak pada Penyakit Jantung Koroner

2013 ◽  
pp. 60-5
Author(s):  
Sony Hilal Wicaksono ◽  
Fachmi Ahmad Muslim ◽  
Vienna Rossimarina
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Single Photon ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Spect Mpi ◽  
Single Photon Emission Computed ◽  
Magnetic Resonance Imaging Mri ◽  
Photon Emission Computed Tomography ◽  
Tomography Scan

Seorang pasien dapat didiagnosis penyakit jantung koroner (PJK) melalui empat cara: kematian jantung mendadak, sindrom koroner akut, angina pektoris stabil paska revaskularisasi, dan hasil diagnostik noninvasif (Computed Tomography scan/CT scan koroner, Single Photon Emission Computed Tomography Myocardial Perfusion Imaging/SPECT MPI nuklir atau Magnetic Resonance Imaging/MRI)1. Pemeriksaan noninvasif memegang peranan penting, yaitu sebagai satu-satunya cara mendiagnosis PJK asimtomatik. Oleh sebab itu, pemahaman mengenai interpretasi hasil pemeriksaan noninvasif seperti CT scan koroner, SPECT MPI nuklir atau MRI kardiak dimasukkan dalam kompetensi dasar program pendidikan spesialis jantung dan pembuluh darah menurut Kolegium PERKI.

scholarly journals Pediatric Scaphoid Nonunions: A Case Series, Review of the Literature, and Evidence-Based Guidelines

2019 ◽  
Vol 09 (01) ◽  
pp. 002-012 ◽  
Author(s):  
Kerstin Oestreich ◽  
Tatiana Umata Yoko Jacomel ◽  
Sami Hassan ◽  
Maxim David Horwitz ◽  
Tommy Roger Lindau
Keyword(s):  
Nonoperative Management ◽  
Pediatric Population ◽  
Scaphoid Fracture ◽  
Case Series ◽  
Fracture Site ◽  
X Rays ◽  
Review Of The Literature ◽  
Level Of Evidence ◽  
Scaphoid Fractures ◽  
Magnetic Resonance Imaging Mri

Abstract Background Scaphoid fractures represent less than 3% of hand and wrist fractures in the pediatric population. Nonunions are very rare. We present a case series (n = 18) of nonunions in skeletally immature children and adolescents. We further present a review of the literature on pediatric scaphoid nonunions. Materials and Methods We reviewed the literature by searching the main databases on pediatric scaphoid nonunions, but to identify factors that lead to nonunion, we also searched for databases on scaphoid fractures. Seventy articles were found for the period between 1961 and 2019, all with level 4/5 evidence. Results The nonunion rate of pediatric scaphoid fractures in the literature is on average 1.5%, occurring mostly as a result of missed or underdiagnosed injuries, similar to our presented case series. Half (n = 9) of the injuries in our case series were missed initial injuries, leading to scaphoid nonunions and half developed nonunions after initial treatment. We found excellent outcomes and with surgical and nonoperative management, with few complications. Not surprisingly, the duration of immobilization is longer with nonoperative management. Conclusions Based on the literature, we recommend a period of nonoperative management before surgery in undisplaced nonunions. In displaced nonunions, open reduction and internal fixation ± bone grafting is necessary. In pediatric scaphoid fractures, similar to adult cases, we identified that suspicious scaphoid fractures should be considered for initial immobilization, and repeat X-rays and early magnetic resonance imaging (MRI) or computed tomography (CT) scans should be considered at follow-up. Immobilization time and type of plaster should be appropriate in relation to the fracture site, similar to the adult scaphoid fracture. Level of Evidence This is a Level IV study.

scholarly journals The Clinical Scaphoid Fracture: Early Computed Tomography as a Practical Approach

2008 ◽  
Vol 90 (6) ◽  
pp. 488-491 ◽  
Author(s):  
Q Nguyen ◽  
S Chaudhry ◽  
R Sloan ◽  
I Bhoora ◽  
C Willard
Keyword(s):  
Ct Scan ◽  
General Hospital ◽  
Scaphoid Fracture ◽  
False Negative ◽  
False Negative Rate ◽  
District General Hospital ◽  
X Rays ◽  
Fracture Clinic ◽  
Non Union ◽  
Scaphoid Fractures

INTRODUCTION Up to 40% of scaphoid fractures are missed at initial presentation as clinical examination and plain radiographs are poor at identifying scaphoid fractures immediately after the injury. Avoiding a delay in diagnosis is essential to prevent the risk of non-union and early wrist arthritis. We demonstrate the use of CT scanning for the early confirmation of a scaphoid fracture. PATIENTS AND METHODS We conducted a retrospective, chronological review of patients who attended an upper limb fracture clinic from January 2001 to October 2003 in a small district general hospital. We performed a CT scan on all ‘clinical scaphoid’ patients who had negative plain X-ray films. RESULTS Overall, 70% of patients had a CT scan within 1 week of injury and not from date of accident and emergency attendance; 83% of patients had a CT scan within 2 weeks of injury. Of 118 patients identified, 32% had positive findings and 22% of ‘clinical scaphoid’ patients had scaphoid fractures. The proportion of positive findings for an acute scaphoid fracture was 68%. Additional pathologies identified on CT were capitate, triquetral and radial fractures. CONCLUSIONS Our audit shows that it is practical to perform CT on suspicious scaphoid fractures in a small district general hospital. We identified an extremely high false-negative rate for plain X-rays and demonstrate that the appropriate use of CT at initial fracture clinic attendance with ‘clinical scaphoid’ leads to an earlier diagnosis and reduces the need for prolonged immobilisation and repeated clinical review.

The Value of Radiographs and Bone Scintigraphy in Suspected Scaphoid Fracture

1993 ◽  
Vol 18 (3) ◽  
pp. 403-406 ◽  
Author(s):  
M. M. C. TIEL-VAN BUUL ◽  
E. J. R. VAN BEEK ◽  
J. J. J. BORM ◽  
F. M. GUBLER ◽  
A. H. BROEKHUIZEN ◽  
...  
Keyword(s):  
Bone Scintigraphy ◽  
Scaphoid Fracture ◽  
Diagnostic Strategy ◽  
Diagnostic Strategies ◽  
Scaphoid Fractures ◽  
Diagnostic Management ◽  
Kappa Value ◽  
Suspected Scaphoid Fracture

The role of radiography and bone scintigraphy in the diagnostic management of suspected scaphoid fracture is controversial. Two strategies were compared for patients with initial negative radiographs: repeated radiography versus selective bone scintigraphy. Using the known positive predictive value of scintigraphy, the sensitivity and specificity of both diagnostic strategies were evaluated in a series of 78 consecutive patients. The kappa value for initial radiographs was 0.76 but decreased to 0.5 for follow-up radiographs. Similarly, sensitivity decreased from 64% to 30% in follow-up radiographs. Specificity of the bone scan was 98%. The best diagnostic strategy in the management of clinically suspected scaphoid fractures consists of initial radiography followed by bone scintigraphy in patients with negative radiographs.

scholarly journals Systematic Review of Diagnosis of Clinically Suspected Scaphoid Fractures

2019 ◽  
Vol 09 (01) ◽  
pp. 081-089
Author(s):  
Henrik Constantin Bäcker ◽  
Chia H. Wu ◽  
Robert J. Strauch
Keyword(s):  
Systematic Review ◽  
Ct Scan ◽  
Bone Scintigraphy ◽  
Sensitivity And Specificity ◽  
Imaging Modality ◽  
Scaphoid Fracture ◽  
Diagnostic Tools ◽  
Search Term ◽  
X Rays ◽  
Scaphoid Fractures

Background Scaphoid fracture accounts for approximately 15% of acute wrist fractures. Clinical examination and plain X-rays are commonly used to diagnose the fracture, but this approach may miss up to 16% of fractures in the absence of clear-cut lucent lines on plain radiographs. As such, additional imaging may be required. It is not clear which imaging modality is the best. The goal of this study is to summarize the current literature on scaphoid fractures to evaluate the sensitivity, specificity, and accuracy of four different imaging modalities. Case Description A systematic-review and meta-analysis was performed. The search term “scaphoid fracture” was used and all prospective articles investigating magnetic resonance imaging (MRI), computed tomography (CT), bone scintigraphy, and ultrasound were included. In total, 2,808 abstracts were reviewed. Of these, 42 articles investigating 51 different diagnostic tools in 2,507 patients were included. Literature Review The mean age was 34.1 ± 5.7 years, and the overall incidence of scaphoid fractures missed on X-ray and diagnosed on advanced imaging was 21.8%. MRI had the highest sensitivity and specificity for diagnosing scaphoid fractures, which were 94.2 and 97.7%, respectively, followed by CT scan with a sensitivity and specificity at 81.5 and 96.0%, respectively. The sensitivity and specificity of ultrasound were 81.5 and 77.4%, respectively. Significant differences between MRI, bone scintigraphy, CT, and ultrasound were identified. Clinical Relevance MRI has higher sensitivity and specificity than CT scan, bone scintigraphy, or ultrasound. Level of Evidence This is a Level II systematic review.

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 Non-aneurysmal subarachnoid hemorrhage: When is a second angiography indicated?

2017 ◽  
Vol 31 (3) ◽  
pp. 244-252 ◽  
Author(s):  
Asma Bashir ◽  
Ronni Mikkelsen ◽  
Leif Sørensen ◽  
Niels Sunde
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Ct Scan ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Artery Aneurysm ◽  
Diagnostic Workup ◽  
Vascular Pathology ◽  
Vascular Abnormalities ◽  
Magnetic Resonance Imaging Mri ◽  
Anterior Choroidal

Purpose Repeat imaging in patients with non-aneurysmal subarachnoid hemorrhage (NASAH) remains controversial. We aim to report our experience with NASAH with different hemorrhage patterns, and to investigate the need for further diagnostic workup to determine the underlying cause of hemorrhage. Method We conducted a retrospective analysis of all spontaneous SAH with an initial negative computed tomography (CT) with angiography (CTA) and/or digital subtraction angiography (DSA) from October 2011 through May 2017. According to the bleeding pattern on the admission CT scan, NASAH was divided into two subgroups: (1) perimesencephalic SAH (PMSAH) and (2) non-perimesencephalic SAH (nPMSAH). Radiological data included the admission CT, CTA, DSA, and magnetic resonance imaging (MRI) with angiography (MRA). Results Seventy-four patients met the inclusion criteria. Thirty-nine (52.7%) patients had PMSAH on the initial CT scan, and 35 (47.3%) had nPMSAH. All underwent CTA and/or DSA revealing no vascular abnormalities. Forty-seven (63.5%) patients underwent subsequent diagnostic workup. DSA was performed in all patients at least once. No abnormalities were found on the repeat DSA or other radiological follow-up studies except in one (1.4%) patient with nPMSAH, in whom a follow-up DSA revealed a small saccular anterior choroidal artery aneurysm, considered to be the source of hemorrhage. Conclusion A repeat DSA may not be needed in case of PMSAH, if the initial negative DSA is technically adequate with absence of hematoma and vasospasm. In contrast, a follow-up DSA should be mandatory for confirming or excluding vascular pathology in case of nPMSAH in order to prevent rebleeding.

scholarly journals Simultaneous Fractures of the Ipsilateral Scaphoid and Distal Radius

2018 ◽  
Vol 07 (04) ◽  
pp. 303-311 ◽  
Author(s):  
Elizabeth Fitzpatrick ◽  
Timothy Fowler
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Scaphoid Fracture ◽  
High Energy ◽  
Fracture Pattern ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Radius Fractures ◽  
Scaphoid Fractures

Background Ipsilateral fractures of the distal radius and scaphoid are rare, with few reports describing mechanisms of injury, fracture patterns, and treatment approaches. Purpose This article describes the clinical and radiographic features of ipsilateral distal radius and scaphoid fractures occurring simultaneously. Materials and Methods Electronic databases from 2007 to 2017 at a single Level 1 trauma center were reviewed for patients with concurrent fractures of the distal radius and scaphoid. Patient demographics, injury mechanism, scaphoid and distal radius fracture pattern, treatment approach, and radiographic healing were studied. Results Twenty-three patients were identified. Nineteen of the 23 (83%) were males, and 19 of 23 (83%) of the injury mechanisms were considered high energy. Twenty-two of the 23 (96%) scaphoid fractures were nondisplaced, all treated with screw fixation. Most distal radius fractures were displaced and comminuted, 17 of 23 (74%) were intra-articular. All distal radius fractures were treated surgically with internal and/or external fixation. Three patients were lost to follow-up. Average follow-up of the remaining 20 was to 19.8 weeks. Nineteen of the 20 (95%) scaphoids healed, one scaphoid went on to nonunion with avascular necrosis. All 20 radius fractures healed, 16 of 20 (80%) in anatomic alignment. Conclusion Ipsilateral fractures of the distal radius and scaphoid are rare and are usually result of high-energy mechanisms. The scaphoid fracture is usually a nondisplaced fracture at the waist. The distal radius fracture pattern varies but most are displaced and comminuted. The union rate of the scaphoid is high, even if subjected to radiocarpal distraction required for distal radius management. Level of Evidence Therapeutic level IV study.

CT of the Wrist in Suspected Scaphoid Fracture

1992 ◽  
Vol 33 (5) ◽  
pp. 500-501 ◽  
Author(s):  
K. Jonsson ◽  
Á. Jónsson ◽  
M. Sloth ◽  
P. Kopylov ◽  
H. Wingstrand
Keyword(s):  
Nuclear Medicine ◽  
Bone Scan ◽  
Scaphoid Fracture ◽  
Plain Radiographs ◽  
Ct Examination ◽  
Scaphoid Fractures ◽  
Suspected Scaphoid Fracture ◽  
Rule Out

Bone scan and sagittal projection CT of the scaphoid was performed in 10 patients with clinically suspected scaphoid fractures. The primary and follow-up plain radiographs were negative or equivocal for fracture. CT examination demonstrated scaphoid fracture in 7 patients and normal findings in 3. It is concluded that CT of the scaphoid can replace bone scan to diagnose or rule out fracture in institutions where nuclear medicine facilities are not available.

Chronic Perineal Pain Related to Sacral Meningeal Cysts

Neurosurgery ◽  
1991 ◽  
Vol 29 (2) ◽  
pp. 223-226 ◽  
Author(s):  
Erik Van de Kelft ◽  
Michel Van Vyve
Keyword(s):  
Ct Scan ◽  
Perineal Pain ◽  
Resonance Imaging ◽  
Mri Scan ◽  
Computed Tomographic ◽  
Clinical Neurological Examination ◽  
Chronic Perineal Pain ◽  
Magnetic Resonance Imaging Mri ◽  
Meningeal Cysts

Abstract Chronic perineal pain is an often encountered problem that is difficult to evaluate. Based on a series of 17 patients in whom urological, gynecological, and anorectal pathology was excluded, the authors compared magnetic resonance imaging (MRI) with computed tomographic (CT) scan with myelography in the investigation of chronic perineal pain. After a clinical neurological examination, patients underwent radiodiagnostic imaging of both techniques. Thirteen patients (76%) had one or more sacral meningeal cysts (MC) on MRI scan, whereas CT scan with myelography of the lumbar and sacral region revealed 7 patients (41%) with sacral MC. Sacral MC may be the etiology of chronic perineal pain in many instances, and MRI scan appears to be superior to CT scan with myelography in demonstrating sacral MC. Ten patients with sacral MC were operated on with moderate to excellent results 6 months after operation. Early postoperative results are encouraging, but further follow-up and larger series are required.

Sign in / Sign up

Export Citation Format

Share Document