Aims. There is a lack of published evidence relating to the rate of nonunion seen in occult
Aims. The aim of this study was to describe the introduction of a virtual pathway for the management of patients with a suspected fracture of the scaphoid, and to report patient-reported outcome measures (PROMs) and satisfaction following treatment using this service. Methods. All adult patients who presented with a clinically suspected
Aims. Besides conventional radiographs, the use of MRI, CT, and bone scintigraphy is frequent in the diagnosis of a fracture of the scaphoid. However, which techniques give the best results remain unknown. The investigation of a new imaging technique initially requires an analysis of its precision. The primary aim of this study was to investigate the interobserver agreement of high-resolution peripheral quantitative CT (HR-pQCT) in the diagnosis of a
Aims. There has been an increasing use of early operative fixation for
Follow-up radiographs are usually used as the
reference standard for the diagnosis of suspected
The use of pulsed electromagnetic fields (PEMF)
to stimulate bone growth has been recommended as an alternative to
the surgical treatment of ununited
We hypothesised that the use of pulsed electromagnetic
field (PEMF) bone growth stimulation in acute scaphoid fractures
would significantly shorten the time to union and reduce the number
of nonunions in a randomised, double-blind, placebo-controlled multicentre
trial. A total of 102 patients (78 male, 24 female; mean age 35
years (18 to 77)) from five different medical centres with a unilateral
undisplaced acute
We evaluated 100 consecutive patients with a suspected
The results of a prospective multicentre study of the Herbert differential pitch bone screw used to treat 50
We have assessed the value of using a simple apparatus, the Carpal Box, in patients with suspected
Inter-observer agreement and reproducibility of opinion were assessed for the radiographic diagnosis of union of
Radiographs of the scaphoid after injury are difficult to interpret, and bone scintigraphy is widely used to increase the accuracy of diagnosis, though many fractures suspected on scintigraphy cannot be confirmed radiologically. We have reviewed the clinical consequences, after one year, of managing suspected
Various classifications of
Twenty observers reported independently on the presence or absence of a fracture of the scaphoid on 60 sets of radiographs; these included initial and 2- to 3-week views in patients in whom the outcome was known, normal scaphoids and random copies of these. Analysis of variance of the accuracy of observations revealed that the 2- to 3-week radiographs did not improve diagnostic ability and that this was independent of the experience or seniority of the observer. For normal radiographs, 20% of the observations reported a fracture. Reproducibility of opinion improved with experience but this did not help with accuracy. Radiographs without accurate clinical observation should not determine the management of the suspected
Delayed union or non-union of the scaphoid was treated by a bone graft on a pronator quadratus pedicle in eight cases. This produced earlier union than the Russe procedure. The procedure is simple and is recommended for old un-united
Aims. This study explores the epidemiology of patients with a fracture
of the scaphoid presenting to a regional teaching hospital. Patients and Methods. All patients with a confirmed fracture of the scaphoid over a
retrospective period between January 2010 and May 2013 were included.
Their demographics, deprivation status and when the fracture occurred
was noted and assessed. There were 415 fractures in 365 males and
50 females. Results. The incidence of fracture of the scaphoid was 12.4 in 100 000
each year in the general population. The mean age of the patients
was 22 years (nine to 35); the highest incidence was in males aged
between 15 and 19 years. We calculate the annual incidence in the
United Kingdom to be 7265 each year. Patients with the lowest socioeconomic status
had an incidence of 18.57 in 100 000 whereas the least deprived
patients had an incidence of 9.98 (p <
0.001). There was evidence
of a seasonal trend (p = 0.022) with the highest monthly rate found
in June (16.96 in 100 000 each year) and the lowest was in December
(7.61 in 100 000 each year). There were significantly fewer presentations of
fracture at the weekend (p <
0.001), and the highest incidence
was on Mondays. Most fractures occurred at the waist (64%) and tubercle
(18.1%). Take home message: In this large-scale epidemiological study,
we confirmed that young men are most at risk of sustaining a fracture
of the scaphoid, and report new factors in relation to social deprivation
and seasonality that influence
The aim of the Scaphoid Magnetic Resonance Imaging in Trauma (SMaRT) trial was to evaluate the clinical and cost implications of using immediate MRI in the acute management of patients with a suspected fracture of the scaphoid with negative radiographs. Patients who presented to the emergency department (ED) with a suspected fracture of the scaphoid and negative radiographs were randomized to a control group, who did not undergo further imaging in the ED, or an intervention group, who had an MRI of the wrist as an additional test during the initial ED attendance. Most participants were male (52% control, 61% intervention), with a mean age of 36.2 years (18 to 73) in the control group and 38.2 years (20 to 71) in the intervention group. The primary outcome was total cost impact at three months post-recruitment. Secondary outcomes included total costs at six months, the assessment of clinical findings, diagnostic accuracy, and the participants’ self-reported level of satisfaction. Differences in cost were estimated using generalized linear models with gamma errors.Aims
Patients and Methods
We studied 45 patients with 46 fractures of the scaphoid who presented sequentially over a period of 21 months. MRI enabled us to relate the pattern of the fracture to the blood supply of the scaphoid. Serial MRI studies of the four main patterns showed that each followed a constant sequence during healing and failure to progress normally predicted nonunion.