Determining diagnosis of scaphoid healing: Comparison of cone beam CT and X-ray after six weeks of immobilization

Lucia Calisto Farracho,Berenice Moutinot,Angeliki Neroladaki,Marion Hamard,Karel Gorican,Pierre Alexandre Poletti,Jean Yves Beaulieu,Cindy Bouvet,Sana Boudabbous

doi:10.1016/j.ejro.2020.100251

Lucia Calisto Farracho, Berenice Moutinot + Show 7 more

Open Access

https://doi.org/10.1016/j.ejro.2020.100251

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Abstract

PurposeTo assess the accuracy and reliability of using cone beam computed tomography (CBCT) compared to X-ray six weeks after injury for predicting scaphoid union. Materials and methodsOverall; 52 patients with scaphoid fractures between April 2018 and March 2019 were prospectively included in this study. The mean age was 34.52 (13–88) years, and the gender ratio male/female 43/9. Of the fractures, 26 had occurred on the right side, and 26 on the left side. In total, 28 % of patients were manual workers. All patients underwent X-ray and CBCT six weeks after injury. Four readers, two radiologists, and two hand surgeons analyzed the findings using double-blinded X-ray and CBCT and categorized fractures as consolidated based on a 50 % visibility threshold concerning trabecular bridges. Proximal pole sclerosis, communition, cyst formation, and humpback deformity were similarly analyzed for all cases. Agreement between readers was calculated using Kappa, and sensitivity, specificity, and accuracy using RStudio software. The gold standard was the radiologic and clinical follow-up for all patients at two months. ResultsInter-reader agreement between the four readers was moderate concerning X-ray (0.543) but substantial concerning CBCT (0.641). It was almost perfect between seniors regarding CBCT (Kappa = 0.862). Sensitivity, specificity, and accuracy were 0.75–0.78, 0.4, and 0.61–0.64, respectively, for two readers regarding CBCT. The X-ray values were 0.65–0.71, 0.35–0.4, and 0.53–0.59, respectively. ConclusionCBCT proves more accurate and reliable than X-ray for diagnosing scaphoid union at an early follow-up and prevents longer immobilization and interruption of activity or work.

Highlights

Scaphoid fractures occur frequently in young, active patients [1].The scaphoid is the most commonly fractured carpal bone, representing approximately 70 %–80 % of all carpal fractures [2,3] with an annual incidence of 1/10,000 emergencies [4]
52 patients with a scaphoid fracture who underwent XR and cone beam computed tomography (CBCT) six weeks after injury were successively included in the study
Three patients with pain had a previous scaphoid pseudarthrosis that was identified during this new trauma and treated by means of surgery

Summary

Introduction

Scaphoid fractures occur frequently in young, active patients [1].The scaphoid is the most commonly fractured carpal bone, representing approximately 70 %–80 % of all carpal fractures [2,3] with an annual incidence of 1/10,000 emergencies [4]. European Journal of Radiology Open 7 (2020) 100251 surface is covered by cartilage, and its blood supply mainly originates from the radial artery with a retrograde blood flow [5]. This specific configuration increases the risk of pseudarthrosis in fracture cases, as the blood flow to the proximal part is compromised [6,7]. The con sequences of pseudarthrosis can be disastrous, as it possibly leads to the predictable, gradual development of early osteoarthritis, called scaphoid non-union advanced collapse [9]

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