The purpose of this so-called Stecher’s view is to extend and thereby project the scaphoid in its entire length. Optimal visualization of the scaphoid on the dorsopalmar projection is achieved with closed fist and ulnar deviation. 22, 23Ĭonventional radiography, including dorsopalmar and lateral imaging of the wrist are obtained in neutral position. 20, 21 Prosser developed a separate classification system for distal scaphoid fractures which has recently been modified by Clementson et al. A more proximal fracture site has a higher probability of non-union, which is why it has been suggested to define proximal fractures as those within the proximal fifth of the scaphoid. 19 Even though proximal pole fractures are incorporated within the Herbert and Mayo classification they lack a common definition. For comparison, the Mayo classification has a somewhat higher inter-observer reliability than the Herbert and Russe systems. 18 It provides a straight morphologic description that we find practical for clinical use. The Mayo classification that we use at our institution is essentially based on fracture location, and provides an appendix on factors attributable to instability. 17 Vertical oblique fractures, which account for < 5% of scaphoid fractures, are highly unstable, which is why internal fixation is generally recommended. Russe classified scaphoid fractures based on fracture plane orientation into transverse, horizontal oblique and vertical oblique fractures. We find that such an approach may lead to considerable overtreatment. 15, 16 All bi-cortical fractures, except for fractures of the tubercle, are considered unstable and candidates for internal fixation. The most frequently used classification system is Herbert’s classification which is based on expected fracture instability. Available classification systems today are all based on radiographs. The aim of this review is to present an algorithm for diagnosis and treatment of acute scaphoid fractures.įracture classification adds important information for treatment and expected outcome. In cases of suspected scaphoid fracture where the initial radiographs are negative, magnetic resonance imaging (MRI) is recommended for diagnostics, while computed tomography (CT) has proven more reliable and accurate in the assessment of scaphoid fracture characteristics and union. It is well known that scaphoid fractures can be difficult to diagnose on initial radiographs. 3 However, in the case of the non-displaced scaphoid waist fracture, which is the most common among scaphoid fractures, it has been suggested that union can occur after just four to six weeks of immobilization. The serious consequences of non-union, such as progressive degenerative changes and carpal collapse, the so-called SNAC (scaphoid non-union advanced collapse) wrist have for patients, typically young and active, resulted in a restrictive treatment regime with immobilization from eight to 12 weeks. 1, 2 Scaphoid fractures are notorious for being difficult to diagnose as well as to achieve fracture union. Previous studies have shown that a scaphoid fracture is the most common fracture among patients with post-traumatic radial-sided wrist pain. Post-traumatic radial-sided wrist pain is common and can represent a fracture, wrist sprain, ligament disruption or a combination of injuries.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |