INVESTIGATION OF SCAPHOID FRACTURES WITH COMPUTER TOMOGRAPHY (CT- SCAN)

Abstract

378 patients have been studied since 1988 when we started the investigation of scaphoid fractures and pseudarthrosis. 306 patients were scaphoid pseudarthrosis and 72 scaphoid fractures or control of fracture healing. This study consists of 3 groups:

Group l: 72 patients with acute injury of the carpus are examined radiographically and no scaphoid fracture was observed. A scaphoid cast is applied in these patients for 10 days. In follow up, the cast is removed and new comparative radiologic examination is performed. In 30 of these patients a scaphoid fracture was observed and the limb was inmmobilized in a scaphoid cast for 4 weeks. In the remaining 42 patients, in whom a fracture line could not be observed in a simple x-Ray, but continued to have clinical findings, a CT-scan was performed in 2 planes. In 26 patients with no fracture in the CT-scan were discharged, while in the remaining 16 patients with obvious fracture in the CT-scan a scaphoid cast was applied for 4 weeks.

Group 2: 30 patients with scaphoid fracture, from which the cast was removed and the fracture line was still visible in a simple X-Ray were examined with CT-scan in 2 different planes. In 18 we found intense healing of the fracture in all the width of the scaphoid and the patients were discharged . The remaining 12 displayed delayed non union with obvious fracture line in all the width of the scaphoid. These patients were treated operatively, by compressing the fracture line with a Herbert screw.

Group 3: This is the largest group of patients concerning the scaphoid pseudarthrosis and consists a topic of a different study. In conclusion the computer tomography scan in two different planes is the most reliable method for the investigation not only of scaphoid fractures but also of the efficiency of the callus. The contribution of the above method in the study of the scaphoid pdeudarhrosis is very important and valuable.