Scaphoid Fractures Research Articles

Accuracy of wrist fracture detection on radiographs by artificial intelligence compared to human clinicians. A systematic review and meta-analysis

PurposeThe aim of the study is to perform a systematic review and meta-analysis comparing the diagnostic performance of artificial intelligence (AI) and human readers in the detection of wrist fractures. MethodThis study conducted a systematic review following PRISMA guidelines. Medline and Embase databases were searched for relevant articles published up to August 14, 2023. All included studies reported the diagnostic performance of AI to detect wrist fractures, with or without comparison to human readers. A meta-analysis was performed to calculate the pooled sensitivity and specificity of AI and human experts in detecting distal radius, and scaphoid fractures respectively. ResultsOf 213 identified records, 20 studies were included after abstract screening and full-text review. Nine articles examined distal radius fractures, while eight studies examined scaphoid fractures. One study included distal radius and scaphoid fractures, and two studies examined paediatric distal radius fractures. The pooled sensitivity and specificity for AI in detecting distal radius fractures were 0.92 (95% CI 0.88–0.95) and 0.89 (0.84–0.92), respectively. The corresponding values for human readers were 0.95 (0.91–0.97) and 0.94 (0.91–0.96). For scaphoid fractures, pooled sensitivity and specificity for AI were 0.85 (0.73–0.92) and 0.83 (0.76–0.89), while human experts exhibited 0.71 (0.66–0.76) and 0.93 (0.90–0.95), respectively. ConclusionThe results indicate comparable diagnostic accuracy between AI and human readers, especially for distal radius fractures. For the detection of scaphoid fractures, the human readers were similarly sensitive but more specific. These findings underscore the potential of AI to enhance fracture detection accuracy and improve clinical workflow, rather than to replace human intelligence.

An Umbrella Review and Updated Meta-Analysis of Imaging Modalities in Occult Scaphoid and Hip and Femoral Fractures.

Background: Occult fractures may cause multiple morbidities. If occult fractures were detected earlier, complications may be preventable. This umbrella review and updated meta-analysis will aim to evaluate the use of imaging modalities in detecting occult scaphoid and hip fractures. Methods: The protocol for this study is available in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42024525388). The literature search started and ended on 17 March 2024. We searched seven academic databases: MEDLINE, Cochrane Library, Pubmed, Science Direct, Google Scholar, WHO International Clinical Trials Registry Platform, and The Joanna Briggs Institute (JBI) database. The meta-analysis was conducted with the STATA program using the "midas" command. Results: There are four systematic reviews evaluating occult hip and femoral fractures with 6174 patients and two reviews evaluating occult scaphoid fractures with 1355 patients. The prevalence of occult scaphoid fracture and occult hip and femoral fractures is 23.87% (95% CI 18.25-29.49) and 44.8% (95% CI 39.38-51.4), respectively. Magnetic resonance imaging (MRI) had the best posterior probability of positive likelihood ratio (LR+) with 95% and 96% and negative likelihood ratio (LR-) with 0.15% and 1% for both occult scaphoid and hip fractures, respectively, assuming a 25% baseline. MRI could both confirm and exclude occult hip fractures while it can only confirm occult scaphoid fractures. Bone scans are inappropriate for either type of occult fractures The level of evidence for occult scaphoid fracture is weak while it is suggestive for occult hip fractures. Conclusion: The findings strengthen the use of MRI after an initially negative radiograph fracture for occult hip and femoral fractures, with a CT scan as a viable second option.

Demographic Characteristics and Factors Associated with Acute Scaphoid Fractures: An Analysis of 903 Patients

Objectives A comprehensive understanding of the epidemiology of scaphoid fractures is crucial to aid in diagnosing and treating patients with suspected injuries. The study aims to assess demographic characteristics and factors associated with acute scaphoid fractures in adults. Methods A retrospective review identified all patients with acute scaphoid fractures over four years at a single institution. Data collected included baseline demographics (age, biological sex, race, and ethnicity), body mass index, tobacco and alcohol use, pertinent medical history, and treatment modality. Laterality, location, and displacement of the fracture were confirmed on radiographic analysis. Results A total of 903 scaphoid fractures were included. The majority of fractures occurred in males (n=570, 63%) and were in the left hand (54%), unilateral (99%), nondisplaced (71%), and treated definitively with nonoperative management (71%). Nearly two-thirds (66%) of fractures occurred along the scaphoid waist, followed by the distal third of the scaphoid (25%). Proximal third fractures accounted for the smallest proportion of scaphoid fractures (8.6%) but had the highest displacement and surgical intervention rates compared to waist and distal third fractures. Younger age, male sex, fractures of the proximal third, and displaced fractures had higher odds of being treated surgically. Conclusion The scaphoid is one of the most frequently fractured carpal bones. Young adult males may be at an increased risk for injury. Patients with displaced fractures and those involving the proximal third require surgical intervention at higher rates.

TOWARDS UNDERSTANDING MÜLLER-WEISS DISEASE: A UNIVERSAL PLATFORM

BackgroundThe only existing classification of Müller-Weiss Disease (MWD), based solely on Méary's angle, serves neither as guide for prognosis nor treatment. This accounts for lack of gold standard in its management.MethodsNavicular compression, medial extrusion, Kite's angle and metatarsal lengths were measured on all radiographs of 95 feet with MWD. Joints involved, presence and location of navicular fracture were recorded.ResultsWe identified three distinct groups. Group 1 comprises 11 “early-onset” MWD feet, aged 9 to 29 years. These had the greatest compression and medial extrusion, and lowest Kite's angles. All except 1 were index minus and had a lateral navicular fracture. None has required surgery to date. Only 1 has moderate talonavicular joint (TNJ) degeneration.Group 2 comprises 23 “Müller-Weissoid” feet with radiologically normal navicular in their fifties and developing MWD, on average, 4.5 years later. These had the lowest compression and extrusion, and highest Kite's angles. None had complete fracture. All had TNJ arthritis, with early changes at lateral naviculocuneiform joint (NCJ) in 43%. Group 3 “late-onset” MWD, presenting in the sixth decade, is subdivided into 3 sub-groups. Only TNJ is involved in group 3A (16). Group 3B denotes affection of TNJ more than NCJ (20). In group 3C “reverse Müller-Weiss disease”, which affects NCJ more than TNJ (25), second metatarsal overlength is highest of all groups. No difference in age, compression, extrusion and Kite's angle exists among the 3 subgroups. No fracture occurred in group 3A compared to 65% and 32% in groups 3B and 3C, respectively.ConclusionsWith a need to compare like-for-like pathology, the proposed classification provides a common platform for reporting outcomes of different treatment modalities, operative or nonoperative. We theorize pathogenetic pathways in the different groups and propose systematic surgical approaches for each category.

In vivo non-contact regions of proximal scaphoid in six extreme wrist positions

IntroductionFractures of the scaphoid are the most common carpal injuries, account for 80-90% of all carpal fractures. 5-15% nonunion of scaphoid fractures were reported even with adequate primary treatment, which probably progresses to osteoarthritic changes several decades later. Researches regarding to scaphoid physiological characteristic in vitro and in vivo and kinds of trials in clinical practice are being kept on going, which contribute much to our clinical practice. With the advancing wrist arthroscopy, 3D-print patient-specific drill guide, and intraoperative fluoroscopic guidance, dorsal approach (mini-invasive and percutaneous technique) is being popular, through which we can implant the screw in good coincidence with biomechanics and with less disturbing tenuous blood supply of the scaphoid. Investigating the noncontact area of the dorsal proximal scaphoid in different wrist positions can facilitate preoperatively estimating insert point of the screw.Materials and methodsEight volunteers were recruited to accept CT scans in six extreme wrist positions. The images of DICOM mode were imput into the Mimics analytical system, the segmented scaphoid, lunate and radius were exported in mode of ASCII STL and were opened in the software of Geomagic studio. We created four planes based on anatomic markers on the surface of the radius and scaphoid to confine the proximal scaphoid to form the so-called non-contact regions. We measured and compared the areas in six targeted positions.ResultsAmidst six extreme wrist positions, area of the non-contact region in extreme dorsal extension (59.81 ± 26.46 mm2) was significantly the smallest, and it in extreme palmar flexion significantly was largest (170.51 ± 30.44 mm2). The non-contact regions increased in order of dorsal extension, supination, ulnar deviation, radial deviation, pronation and palmar flexion. As for two-group comparison, the non-contact region showed significantly larger (p < 0.05) in palmar flexion than the others except for in pronation individually, and in radial deviation (p < 0.05) than in dorsal extension.ConclusionsSufficient space was available for the screw started from the dorsal approach despite the wrist positions.

Navicular bone fractures in horses: Prognosis after conservative and surgical treatment

The aim of this retrospective study is to describe and compare conservative and surgical treatment of navicular fractures in horses. An attempt is made to identify critical points that can favorably influence the prognosis of this orthopedic disease. All horses treated for a navicular fracture at the Equine Clinic, Vetsuisse Faculty, University of Zurich between 2005 and 2017 were included in this study. The severity of lameness at initial examination, radiographic assessment, hoof conformation, treatment (conservative or surgical), complications and outcome were determined from the medical records. Conservative and surgical treatment consisted of stable rest, a controlled exercise program and therapeutic orthopedic shoeing. During surgical treatment, fracture reduction was also carried out with a cortical screw. Computer assisted surgery were used in five horses and computer tomography in three horses. Follow-up examinations included clinical and radiographic examinations. The outcome was divided into three categories: 1 = very good; 2 = good; 3 = poor. Twelve horses met the inclusion criteria; Four horses were treated conservatively and eight were treated surgically. After conservative treatment, two horses (50 %) had a very good outcome and two (50 %) had a good outcome. After surgical treatment, four horses (50 %) had a very good outcome and four (50 %) had a poor outcome. Overall, 67 % of horses had a very good or good outcome, although radiographic signs of bone healing was not present in any of these cases. Various complications were identified, such as the fracture of a screw, the fragmentation of the small navicular bone fragment, the development of osteoarthrosis in the coffin joint and progressive podotrochosis. This study shows that the prognosis of navicular fractures is generally cautious and that degenerative changes to the navicular apparatus worsen the prognosis. In the present study, surgical treatment did not improve the prognosis of navicular fractures despite the intrasurgical use of three-dimensional imaging. However, technical advances could reduce the complication rate in the future.

Wrist &amp; Hand

The June 2024 Wrist &amp; Hand Roundup360 looks at: One-year outcomes of the anatomical front and back reconstruction for scapholunate dissociation; Limited intercarpal fusion versus proximal row carpectomy in the treatment of SLAC or SNAC wrist: results after 3.5 years; Prognostic factors for clinical outcomes after arthroscopic treatment of traumatic central tears of the triangular fibrocartilage complex; The rate of nonunion in the MRI-detected occult scaphoid fracture: a multicentre cohort study; Does correction of carpal malalignment influence the union rate of scaphoid nonunion surgery?; Provision of a home-based video-assisted therapy programme in thumb carpometacarpal arthroplasty; Is replantation associated with better hand function after traumatic hand amputation than after revision amputation?; Diagnostic performance of artificial intelligence for detection of scaphoid and distal radius fractures: a systematic review.

Deep Learning-Based Surgical Treatment Recommendation and Nonsurgical Prognosis Status Classification for Scaphoid Fractures by Automated X-ray Image Recognition.

Biomedical information retrieval for diagnosis, treatment and prognosis has been studied for a long time. In particular, image recognition using deep learning has been shown to be very effective for cancers and diseases. In these fields, scaphoid fracture recognition is a hot topic because the appearance of scaphoid fractures is not easy to detect. Although there have been a number of recent studies on this topic, no studies focused their attention on surgical treatment recommendations and nonsurgical prognosis status classification. Indeed, a successful treatment recommendation will assist the doctor in selecting an effective treatment, and the prognosis status classification will help a radiologist recognize the image more efficiently. For these purposes, in this paper, we propose potential solutions through a comprehensive empirical study assessing the effectiveness of recent deep learning techniques on surgical treatment recommendation and nonsurgical prognosis status classification. In the proposed system, the scaphoid is firstly segmented from an unknown X-ray image. Next, for surgical treatment recommendation, the fractures are further filtered and recognized. According to the recognition result, the surgical treatment recommendation is generated. Finally, even without sufficient fracture information, the doctor can still make an effective decision to opt for surgery or not. Moreover, for nonsurgical patients, the current prognosis status of avascular necrosis, non-union and union can be classified. The related experimental results made using a real dataset reveal that the surgical treatment recommendation reached 80% and 86% in accuracy and AUC (Area Under the Curve), respectively, while the nonsurgical prognosis status classification reached 91% and 96%, respectively. Further, the methods using transfer learning and data augmentation can bring out obvious improvements, which, on average, reached 21.9%, 28.9% and 5.6%, 7.8% for surgical treatment recommendations and nonsurgical prognosis image classification, respectively. Based on the experimental results, the recommended methods in this paper are DenseNet169 and ResNet50 for surgical treatment recommendation and nonsurgical prognosis status classification, respectively. We believe that this paper can provide an important reference for future research on surgical treatment recommendation and nonsurgical prognosis classification for scaphoid fractures.

PANORAMIC REVIEW OF ACUTE SCAPHOID FRACTURES: DESCRIPTION, EPIDEMIOLOGY, ETIOLOGY, PRESENTATION, DIAGNOSIS, TREATMENT AND PROGNOSIS

Introduction: Scaphoid fractures are the most common fractures of the carpal bone and commonly occur in young males. Inadequate treatment of these fractures commonly leads to pseudarthrosis, resulting in pain and significant disability. Tenderness to palpation and/or pain with axial loading of the thumb should be managed as if it were a scaphoid fracture until proven otherwise. Objective: to detail current information related to scaphoid fractures, description, epidemiology, etiology, presentation, diagnosis, treatment and prognosis. Methodology: a total of 37 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 20 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: fracture, scaphoid, carpal bones, trauma, surgery. Results: Scaphoid fractures account for 2% to 7% of all fractures and 60% to 70% of carpal bone fractures. They are infrequent in children with approximately 3% of all pediatric hand and wrist fractures. Non-displaced fractures have high healing rates with cast treatment. Radiographs may miss fractures up to 25% of the time. Physical therapy is important in both operative and nonoperative treatment. Conclusions: Knowledge of the clinical presentation, diagnosis and treatment of scaphoid fractures is of utmost importance, because sometimes this type of fracture can go undetected on radiographs, which can lead to complications such as pseudarthrosis. The diagnosis of scaphoid fractures is sometimes complicated, so when there is clinical suspicion, appropriate complementary examinations should be performed to better determine the pathological condition, as is the case of computed tomography. Conservative or surgical management will depend on the type of fracture. Smoking cessation is recommended to improve fracture healing and physiotherapy both after surgical and non-surgical treatment. KEY WORDS: fracture, scaphoid, carpal bones, trauma, surgery.

Morphological measurements and classification of the navicular bone: a study based on computed tomography imaging.

The purpose of this study was to present the classification of navicular bones and the anatomical basis for the diagnosis and treatment of navicular fractures of the foot. 351 computed tomographic (CT) images of the navicular bone were analyzed and classified. The navicular bone's anatomical morphology was measured by three independent researchers in each type. Analysis and recording of the measurement results followed. Navicular bones were assorted into three types: I shape(37.04%), II shape(54.41%), and III shape(8.55%). The left and right sides did not differ in any appreciable ways, except ab, bc, and ∠abc (P < 0.05); And all data were statistically different between men and women except for ∠abc (p > 0.05). The classification of the navicular bone in this study may be helpful in making the treatment decision for navicular fracture. 4.

Functional outcome in case of surgically and conservatively treated bilateral distal end radius and scaphoid fracture: a rare case report

Bilateral fractures of the distal radius and scaphoid are extremely rare injuries. Proper preoperative evaluation is a must to know the orientation of the fracture. Treatment must be based on displacement of the fracture. If fracture is displaced, internal fixation is needed but if its stable with minimal displacement, we can conserve it. A patient with displaced distal radius fractures and displaced scaphoid fracture on one side, along with displaced distal end radius fracture and undisplaced scaphoid fracture on the other side, was treated via internal fixation of the scaphoid fractures with Herbert screws and internal fixation of the distal radius fractures with locked volar plating on the right side and below elbow cast in cup holding position on the left side which was non-dominant. The approach to treating fractures hinges on several factors: the specific location and alignment of the fracture, the patient's characteristics, and the surgeon's expertise. For fractures in the distal radius and scaphoid, employing a rigid internal fixation method allows for the early initiation of active wrist rehabilitation, eliminating the necessity for wrist immobilization using a plaster cast or external skeletal fixation. On the other hand, a conservative treatment approach involving a below-elbow cast offers certain advantages, such as minimal blood loss and fewer complications related to wound healing, particularly for undisplaced fractures, especially when they occur in the non-dominant hand.

Spontaneous union of neglected proximal pole scaphoid fracture: A case report

Scaphoid fractures are the most common carpal bone fractures and usually occur due to trauma, typically a fall on an outstretched hand. The scaphoid bone is integral to wrist biomechanics, linking the proximal carpal row to the distal row. Neglected scaphoid fractures can lead to significant long-term complications, with degenerative changes likely to occur. The most common consequence of a neglected scaphoid fracture is known as scaphoid non-union advanced collapse, which typically begins within five years following the injury. It is widely accepted that scaphoid fractures, in general, should be treated to avoid long-term complications. Many surgeons aggressively treat proximal pole fractures with surgical fixation due to the high risk of avascular necrosis. Although some surgeons may consider a period of immobilization, none would argue against the need for treatment of proximal pole fractures, either through immobilization or surgical fixation. In this case, we present an instance of spontaneous union of a neglected proximal pole fracture non-union in a mature adult. This report aims to provide awareness of the possible spontaneous union of neglected proximal pole scaphoid fracture. It also challenges the call for acute aggressive surgical intervention in such fractures. Radiographs and magnetic resonance imaging scan images before and after union are presented, along with a review of the available literature.

Scapholunate Advanced Collapse (SLAC) and Scaphoid Nonunion Advanced Collapse (SNAC): A Review of Treatment Options for Stage II.

Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) represent clinical entities identified by a pattern of predictable degenerative changes. They are the most common causes of wrist arthritis. Both entities can remain asymptomatic for many years and may go undiagnosed. Diagnosis is usually confirmed through clinical examination, which reveals progressive wrist pain and instability. Radiographically, degenerative changes in the radiocarpal and midcarpal joints are present, as well as nonunion of the scaphoid fracture in SNAC. The management differs according to the stage. Particularly in this review article, we reviewed the treatment options for stage II SLAC and SNAC wrist. In addition to the well-described surgical techniques such as proximal row carpectomy and four-corner fusion, alternatives such as capitolunate arthrodesis, three-corner fusion, and soft tissue procedures like capsulodesis and tenodesis are available. Proximal row carpectomy and partial arthrodeses yield comparable results. Soft tissue procedures are viable alternatives and are preferred in younger patients to avoid early salvage operations.

Distal Scaphoid Excision for Chronic and Nonchronic Scaphoid Fracture Nonunion

PurposeThe indications for distal scaphoid excision are limited to localized wrist arthritis surrounding the scaphoid as a result of scaphoid nonunion advanced collapse or scapho-trapezio-trapezoid (STT) joint arthritis. The procedure historically has led to relief of symptoms and improvement in strength. Our aim was to examine the outcomes of this procedure in patients with scaphoid fracture nonunion. MethodsThis is a single-center retrospective case series of 12 consecutive patients who underwent distal scaphoid excision after scaphoid fracture nonunion. Patients were divided into two groups based on nonunion chronicity: chronic (more than a year) and non-chronic (less than a year). Clinical and radiographic data were examined using descriptive statistics. ResultsOur cohort consisted of 12 patients, 10 men (83%) and 2 women (17%), with a mean age 37.6±13.6 years. Eight patients had a chronic scaphoid fracture nonunion (6 had a neglected scaphoid fracture and 2 had a nonunion after scaphoid open reduction and internal fixation (ORIF) with bone graft) and 4 patients had non-chronic fracture non-union (2 had failed cast treatment and 2 had nonunion after scaphoid ORIF with bone graft). Pre-operatively, all patients complained of pain and 4 had numbness (all in chronic group). After an average 21 weeks post-operatively, 7 patients (58%) reported continued pain. Two patients reported ulnar side pain, one underwent arthroscopic synovectomy. All patients who started with normal radiolunate angle continued to have normal angle, whereas patients who had DISI prior to surgery persisted after surgery except for a patient who underwent midcarpal fusion and had their radiolunate angle corrected. ConclusionsDistal scaphoid excision is an effective procedure for carefully selected patients with periscaphoid wrist arthrosis. Patients with recent scaphoid fracture that failed treatment may also be treated with distal scaphoid resection.

The incidence of surgical intervention following a suspected scaphoid fracture.

The underlying natural history of suspected scaphoid fractures (SSFs) is unclear and assumed poor. There is an urgent requirement to develop the literature around SSFs to quantify the actual prevalence of intervention following SSF. Defining the risk of intervention following SSF may influence the need for widespread surveillance and screening of SSF injuries, and could influence medicolegal actions around missed scaphoid fractures. Data on SSF were retrospectively gathered from virtual fracture clinics (VFCs) across a large Scottish Health Board over a four-year period, from 1 January 2018 to 31 December 2021. The Bluespier Electronic Patient Record System identified any surgical procedure being undertaken in relation to a scaphoid injury over the same time period. Isolating patients who underwent surgical intervention for SSF was performed by cross-referencing the unique patient Community Health Index number for patients who underwent these scaphoid procedures with those seen at VFCs for SSF over this four-year period. In total, 1,739 patients were identified as having had a SSF. Five patients (0.28%) underwent early open reduction and internal fixation (ORIF). One patient (0.06%) developed a nonunion and underwent ORIF with bone grafting. All six patients undergoing surgery were male (p = 0.005). The overall rate of intervention following a SSF was 0.35%. The early intervention rate in those undergoing primary MRI was one (0.36%), compared with three in those without (0.27%) (p > 0.576). Surgical intervention was rare following a SSF and was not required in females. A primary MRI policy did not appear to be associated with any change in primary or secondary intervention. These data are the first and largest in recent literature to quantify the prevalence of surgical intervention following a SSF, and may be used to guide surveillance and screening pathways as well as define medicolegal risk involved in missing a true fracture in SSFs.

Bilateral Scaphoid Fractures: A Systematic Literature Review.

Bilateral scaphoid fractures are rare lesions, warranting a review to synthesize current knowledge, identify gaps, and suggest research directions. Two authors, adhering to PRISMA guidelines, in January 2024 identified 16 case reports (1976-2023). Data extraction included demographics, injury mechanisms, associated injuries, fracture sites, treatments, and outcomes. Among 121 initial outcomes, 16 articles met the criteria, predominantly affecting young people (93.75% males, mean age 22 years). High-energy traumas (75%) often caused associated wrist injuries (68.75%). Most fractures required surgical intervention (68.75%), primarily headless compression screws. Bilateral scaphoid fractures, which are rare but associated with high-energy traumas, commonly involve wrist injuries. Surgical management is often necessary, yielding better outcomes with fewer complications. Further research is essential to understand the epidemiology, optimal management, and long-term results. Early diagnosis and appropriate treatment are crucial for preventing complications and ensuring favorable patient outcomes.

HEIGHT-TO-LENGTH RATIOS OBTAINED BY WRIST RADIOGRAPHY TO ASSESS SCAPHOID MALUNION: RADIOGRAPHIC AND CLINICAL OUTCOMES OF 32 CASES

Purpose: Scaphoid nonunion and malunion can be observed after scaphoid fracture. While the diagnosis of nonunion is well defined in the literature, there is no consensus on the diagnostic criteria and clinical outcomes of scaphoid malunion. The aim of the study is to define the direct radiography parameters of scaphoid malunion and determine the clinical outcomes. Methods: Patients applied to our clinic with the diagnosis of scaphoid fracture between January 2020 and June 2021, and were analyzed retrospectively. 32 patients treated with surgical or conservative methods were included in the study. Nonunions and cases with a follow-up period of less than 12 months were excluded. Scapholunate (SL) angles and height-to-length (H/L) ratios of scaphoid were measured on wrist radiography to assess scaphoid malunion. Malunion was defined as SL angle &gt;60° and ROC analysis was applied to determine cutoff H/L ratio in wrist radiography. Wrist functionality and pain were evaluated with the Patient-Rated Wrist Evaluation (PRWE) and MAYO scores. The range of motion (ROM) and grip strength were also recorded. Results: Seventeen patients (53.1%) underwent surgery while conservative treatment was applied to the other 15 (46.9%). Of these, six patients (18.8%) met the definition of malunion. According to receiver operating curve (ROC) analysis, the cutoff H/L ratio in posteroanterior wrist radiographs was 0.602 ([Formula: see text] &lt; 0.001) and the cutoff H/L ratio in lateral wrist radiographs was 0.692 ([Formula: see text] = 0.003). The ROM values for flexion/extension and radial/ulnar deviation was smaller in the malunion group ([Formula: see text] = 0.023 and [Formula: see text] = 0.014, respectively). However, no significant difference was observed in pronation/supination values ([Formula: see text] &gt; 0.05). Mean MAYO score was 75.0 in malunion group and 90.0 in nonmalunion group ([Formula: see text] = 0.003). While the mean PRWE value was 24.50 in malunion, it was 14.15 in nonmalunion ([Formula: see text] = 0.023). Conclusion: Evaluation of H/L ratio in wrist radiography provides valuable information in the diagnosis of scaphoid malunion. Scaphoid malunions have poorer functional outcomes.

The rate of nonunion in the MRI-detected occult scaphoid fracture.

There is a lack of published evidence relating to the rate of nonunion seen in occult scaphoid fractures, diagnosed only after MRI. This study reports the rate of delayed union and nonunion in a cohort of patients with MRI-detected acute scaphoid fractures. This multicentre cohort study at eight centres in the UK included all patients with an acute scaphoid fracture diagnosed on MRI having presented acutely following wrist trauma with normal radiographs. Data were gathered retrospectively for a minimum of 12 months at each centre. The primary outcome measures were the rate of acute surgery, delayed union, and nonunion. A total of 1,989 patients underwent acute MRI for a suspected scaphoid fracture during the study period, of which 256 patients (12.9%) were diagnosed with a previously occult scaphoid fracture. Of the patients with scaphoid fractures, six underwent early surgical fixation (2.3%) and there was a total of 16 cases of delayed or nonunion (6.3%) in the remaining 250 patients treated with cast immobilization. Of the nine nonunions (3.5%), seven underwent surgery (2.7%), one opted for non-surgical treatment, and one failed to attend follow-up. Of the seven delayed unions (2.7%), one (0.4%) was treated with surgery at two months, one (0.4%) did not attend further follow-up, and the remaining five fractures (1.9%) healed after further cast immobilization. All fractures treated with surgery had united at follow-up. There was one complication of surgery (prominent screw requiring removal). MRI-detected scaphoid fractures are not universally benign, with delayed or nonunion of scaphoid fractures diagnosed only after MRI seen in over 6% despite appropriate initial immobilization, with most of these patients with nonunion requiring surgery to achieve union. This study adds weight to the evidence base supporting the use of early MRI for these patients.

Anatomy of the Naviculocuneiform Joint Complex.

The purpose of this study was to quantify the articular surfaces of the naviculocuneiform (NC) joint to help clinicians better understand common pathologies observed such as navicular stress fractures and arthrodesis nonunions. Twenty cadaver NC joints were dissected and the articular cartilage of the navicular, medial, middle, and lateral cuneiforms were quantified by calibrated digital imaging software. Statistical analysis included calculating the mean cartilage surface area dimensions of the distal navicular and proximal cuneiform bones. Length measurements on the navicular were obtained to estimate the geographic location of the interfacet ridges. Lastly, all facets of the articular surfaces were described in regard to the shape and location of cartilaginous or fibrous components. Results were compared using Student t tests. Navicular cartilage was present over 75.4% of the surface area of the proximal NC joint, compared with 72.6% of combined cuneiform cartilage distally. The mean height of the deepest (dorsal-plantar) measurement of navicular articular cartilage was 18 ± 3 mm. The mean heights of the distal medial, middle, and lateral cuneiform articular facets were 15 ± 1 mm, 17 ± 2 mm, and 15 ± 2 mm, respectively. There is significant variation among the articular surfaces of the NC joint. Additionally, the central third of the navicular was calculated to lie in the inter-facet ridge between the medial and middle articular facets of the navicular. Surgeons may consider this study data when performing joint preparation for NC arthrodesis as cartilage was present to a mean depth of 18 mm at the NC joint. Additionally, this study demonstrates that the central third of the navicular, where most navicular stress fractures occur, lies in the interfacet ridge between the medial and middle articular facets of the navicular.

Distal Radial Fractures with Scaphoid Fractures.

Objective This study evaluated the epidemiological data and functional outcomes from patients with concomitant distal radial and scaphoid fractures treated in a single center specialized in hand surgery. Functional outcomes analysis used validated instruments. Methods Patients diagnosed with distal radial and scaphoid fractures treated from January 2011 to December 2021 underwent assessments using the Disabilities of the Arm, Shoulder and Hand (DASH), Patient-Rated Wrist Evaluation (PRWE), Visual Analog Scale (VAS) for pain, goniometry, radiographic consolidation, and complications six months after surgery. Results The study included 23 patients, 73.9% men and 26.1% women. Most (56.5%) fractures occurred on the right side, and 43.5% happened on the left side. Treatment of most (56%) distal radial fractures used a locked volar plate. Functional assessment by PRWE resulted in a mean score of 35.9 points (range, 14 to 71 points), while DASH showed a mean score of 37.8 points (range, 12 to 78 points). The mean VAS was 2.33 during activities (range, 0.6 to 6.2). Conclusion Distal radial fractures associated with scaphoid fractures resulted from high-energy trauma, and most patients were males. There was a low rate of complications with surgical treatment, and the patients had satisfactory functional evolution with a low level of pain.