Abstract
We investigated the role of three-dimensional (3-D) CT in the diagnosis and management of four bipartite scaphoids in three patients. We computed the volume ratio, moment of inertia ratio and direction vector from the centroid of the scaphoid to the os centrale carpi. We found that the os centrale carpi was always smaller than the scaphoid and showed an elongated shape in the scaphoid longitudinal axis. Its position was always posterior compared with the scaphoid anteroposterior axis. The main morphological feature of bipartite scaphoids was the continuity of the scaphoid from its proximal to distal aspect along the longitudinal axis. These criteria from 3-D imaging should be considered useful in the diagnosis of bipartite scaphoid as it allows differentiation from nonunion. 3-D single-photon emission computed tomography (SPECT)/CT was helpful in the surgical decision-making when the patient was symptomatic. 3-D imaging was also used for the preoperative simulation and planning of bone fusion as it simplifies surgery and makes it more accurate. Here we provide clear criteria for diagnosing bipartite scaphoids and for the planning when surgery is deemed necessary.
Highlights
The scaphoid bone is formed by the fusion of the os centrale carpi and the radial chondrification centre in embryos measuring between 28 to 30 mm long (Gray, 1957)
The moment of inertia ratio showed an elongated shape for both the scaphoid and os centrale carpi because of a higher distribution of mass around the x-axis and y-axis compared with the z-axis
We found that 3-D imaging with CT and/or single-photon emission computed tomography (SPECT)/CT was an important and useful tool in the diagnosis of bipartite scaphoid
Summary
The scaphoid bone is formed by the fusion of the os centrale carpi and the radial chondrification centre in embryos measuring between 28 to 30 mm long (Gray, 1957). Several authors (Bunnell and Boyes, 1970; Jerre, 1947; Talesnik, 1985) have suggested various criteria for the diagnosis of bipartite scaphoid, such as bilateral partition, absence of history or sign of injury, clear space between the bony components with smooth edges at the joint surface, equal size and bone densification of each part and absence of degenerative changes in the radioscaphoid joint. These criteria are not always sufficient to avoid misdiagnosing
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