Computed tomography (CT) is increasingly used not just to diagnose union but also to estimate the percentage of the fracture gap that is bridged by healing bone. This study tested the primary null hypothesis that there is no agreement between observers on the extent of union of a scaphoid waist fracture on CT. CT scans of 13 nondisplaced scaphoid waist fractures treated nonoperatively were rated by 145 observers. CT scans were done 10 to 12 weeks after injury. Observers were asked to "eyeball" measure percentage of union. We found that there was a moderate agreement on the categorical degree of partial union of a scaphoid waist fracture on CT (k = 0.34). Agreement on the location of bony bridging was slight (k = 0.31). We concluded that there is limited reliability of diagnosis of partial union of a scaphoid waist fracture on CT and that this should be taken into account in both patient care and research. This is a Level III, diagnostic study.
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| http://dx.doi.org/10.1055/s-0038-1636831 | DOI Listing |
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Introduction: The goal of this work is to determine, using the analysis of our own patient group and current professional publications, in which cases fractures of the scaphoid waist can be treated conservatively by short-term plaster fixation with a low risk of non-union developing.
Material And Method: A group of 19 patients (17 men and 2 women) with the mean age 31 years (range 20-43, SD 7.3) with fractures of scaphoid waist were indicated for conservative treatment.
Article Synopsis
- The study investigates the effectiveness of two types of bone grafts (packed cancellous vs. corticocancellous) used in repairing scaphoid waist nonunion fractures with volar locking plates.
- Postoperative CT scans showed that 95% of patients achieved osseous bridging, but those with packed cancellous grafts had significantly better healing outcomes than those with corticocancellous grafts.
- The findings suggest that using packed cancellous autografts may lead to faster and more effective bone healing in these cases.
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University of Kansas Medical Center, Department of Plastic, Burn, and Wound Surgery, Kansas City, KS.
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Cureus
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Orthopedics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, GBR.
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