Importance of Computed Tomography in Determining Displacement in Scaphoid Fractures
03 November 2016
04 June 2017
06 July 2017 (eFirst)
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.
Ethical Board Approval
Institutional ethical board review approval was obtained from the Hospital for Special Surgery's Institutional Review Board.
This work was performed at the Hospital for Special Surgery, New York.
- 1 Osterman AL, Mikulics M. Scaphoid nonunion. Hand Clin 1988; 4 (03) 437-455
- 2 Kuschner SH, Lane CS, Brien WW, Gellman H. Scaphoid fractures and scaphoid nonunion. Diagnosis and treatment. Orthop Rev 1994; 23 (11) 861-871
- 3 Singh HP, Taub N, Dias JJ. Management of displaced fractures of the waist of the scaphoid: meta-analyses of comparative studies. Injury 2012; 43 (06) 933-939
- 4 Cooney WP, Dobyns JH, Linscheid RL. Fractures of the scaphoid: a rational approach to management. Clin Orthop Relat Res 1980; (149) 90-97
- 5 Amadio P, Moran S. Fractures of the carpal bones. In: Green D. , ed. Operative Hand Surgery. Philadelphia, PA: Elsevier; 2005: 711-768
- 6 Amadio PC, Berquist TH, Smith DK, Ilstrup DM, Cooney III WP, Linscheid RL. Scaphoid malunion. J Hand Surg Am 1989; 14 (04) 679-687
- 7 Bain GI, Bennett JD, MacDermid JC, Slethaug GP, Richards RS, Roth JH. Measurement of the scaphoid humpback deformity using longitudinal computed tomography: intra- and interobserver variability using various measurement techniques. J Hand Surg Am 1998; 23 (01) 76-81
- 8 Roh YH, Noh JH, Lee BK. , et al. Reliability and validity of carpal alignment measurements in evaluating deformities of scaphoid fractures. Arch Orthop Trauma Surg 2014; 134 (06) 887-893
- 9 Szabo RM, Manske D. Displaced fractures of the scaphoid. Clin Orthop Relat Res 1988; (230) 30-38
- 10 Dabezies EJ, Mathews R, Faust DC. Injuries to the carpus. Orthopedics 1982; 5 (11) 1510-1521
- 11 Bhat M, McCarthy M, Davis TR, Oni JA, Dawson S. MRI and plain radiography in the assessment of displaced fractures of the waist of the carpal scaphoid. J Bone Joint Surg Br 2004; 86 (05) 705-713
- 12 Thorleifsson R, Karlsson J, Sigurjonsson K. Fractures of the scaphoid bone. A follow-up study. Arch Orthop Trauma Surg 1984; 103 (02) 96-99
- 13 Cooney WP, Linscheid RL, Dobyns JH, Wood MB. Scaphoid nonunion: role of anterior interpositional bone grafts. J Hand Surg Am 1988; 13 (05) 635-650
- 14 Temple CL, Ross DC, Bennett JD, Garvin GJ, King GJ, Faber KJ. Comparison of sagittal computed tomography and plain film radiography in a scaphoid fracture model. J Hand Surg Am 2005; 30 (03) 534-542
- 15 Lozano-Calderón S, Blazar P, Zurakowski D, Lee SG, Ring D. Diagnosis of scaphoid fracture displacement with radiography and computed tomography. J Bone Joint Surg Am 2006; 88 (12) 2695-2703
- 16 Bernard SA, Murray PM, Heckman MG. Validity of conventional radiography in determining scaphoid waist fracture displacement. J Orthop Trauma 2010; 24 (07) 448-451
- 17 Buijze GA, Jørgsholm P, Thomsen NO, Bjorkman A, Besjakov J, Ring D. Diagnostic performance of radiographs and computed tomography for displacement and instability of acute scaphoid waist fractures. J Bone Joint Surg Am 2012; 94 (21) 1967-1974
- 18 Megerle K, Harenberg PS, Germann G, Hellmich S. Scaphoid morphology and clinical outcomes in scaphoid reconstructions. Injury 2012; 43 (03) 306-310
- 19 Lynch NM, Linscheid RL. Corrective osteotomy for scaphoid malunion: technique and long-term follow-up evaluation. J Hand Surg Am 1997; 22 (01) 35-43