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At least 739 records · Page 41Linked to original sources
PubMed2005

Use of early magnetic resonance imaging in the diagnosis of occult scaphoid fractures: the CAST Study (Canberra Area Scaphoid Trial).

AIM: To establish the effectiveness of early magnetic resonance imaging (MRI) in the diagnosis of scaphoid fracture in patients with suggestive clinical findings (but a normal initial X-ray) in an Australian major-referral emergency department METHODS: A prospective study of patients who presented within 24 hours after trauma with clinical findings suggestive of a scaphoid fracture but no evidence of fracture on the initial X-ray. MRI was performed within 24 hours of presentation. Clinical review in patients with normal initial MRI was carried out in 10 days and repeat MRI was carried out when clinically indicated. RESULTS: A total of 22 patients were enrolled. Early MRI within 24 hours revealed 6 scaphoid fractures, 2 distal radial fractures and a hamate fracture. Thirteen patients had no fracture on the initial MRI. Upon clinical review in 10 days, 5 of these patients were clinically cleared and discharged. Eight of these patients underwent repeat MRI none of which revealed a fracture. CONCLUSIONS: In an Australian tertiary hospital with MRI facility, the early use of MRI is a sensitive and practical way to diagnose occult scaphoid fractures and saves unnecessary immobilisation.

Adolescent↗
PubMedDate not supplied

Update on the evaluation of wrist pain.

Wrist pain is a common presenting complaint in patients both for the hand specialist and the primary care physician. Knowledge of wrist anatomy and a thorough and systematic wrist examination remain the mainstays of evaluation. Radiologic as well as arthroscopic technology and techniques continue to evolve and provide useful adjuncts to wrist evaluation that expand our diagnostic and therapeutic capabilities.

Arthralgia↗
PubMed2000

MRI in the management of scaphoid fractures in skeletally immature patients.

BACKGROUND: The scaphoid is the commonest fractured carpal bone, but excluding a scaphoid fracture with plain radiographs is difficult. Other imaging modalities are being increasingly evaluated in the management of scaphoid injuries. MRI has been shown to be of considerable value in the adult population but there have been limited studies of its use in children. PURPOSE: To evaluate the role of MRI in the acute management of suspected scaphoid injuries in children. METHODS AND MATERIALS: Fifty-six children (57 injuries) who had a suspected scaphoid injury underwent MRI within 10 days of their initial trauma. The results of MRI were used to dictate management of the injury. RESULTS: In 33 (58%) of the 57 injuries, MRI was normal and the patient was discharged from care. In 16 cases (28%), a fractured scaphoid was diagnosed and appropriate treatment started early. Additionally, other fractures around the wrist joint and ganglion cysts were demonstrated on MRI. CONCLUSIONS: MRI of acute scaphoid injuries in children significantly alters management. Those children with normal scans are discharged earlier. Scaphoid fractures are confirmed earlier and other pathological conditions are also detected.

Adolescent↗
PubMed2006

Treatment of scaphoid non-unions by a palmar approach with vascularised bone graft harvested from the thumb.

Ten patients with scaphoid non-unions which had been present for longer than 2 years were treated using a vascularised bone graft harvested from the thumb and pedicled on the first dorsal metacarpal artery. Bone harvesting and grafting were performed by a single palmar approach. Concomitant cancellous bone graft was not used. Bone healing was confirmed by CT scans in nine of the ten patients. Persistence of the non-union was observed in one patient who was the oldest in this series, had the longest standing non-union and was a heavy smoker. Twelve months after surgery, nine of the ten patients had significant pain relief with an improved range of motion and grip strength.

Adult↗
PubMed2006

Bone density comparison of selected carpal and tarsal bones: validation for their use in compression fracture fixation studies of scaphoid screws.

INTRODUCTION: To determine if trabecular, total and cortical bone densities of the capitate, navicular, cuboid, and first cuneiform were equivalent to those of the scaphoid, such that these bones could be used in place of the scaphoid in evaluating new headless scaphoid compression screws. METHODS: Fifty scaphoids, capitates, naviculars, cuboids, and first cuneiforms were harvested from fresh frozen cadavers. The trabecular, total and cortical bone densities were measured using pQCT technology and statistically compared. RESULTS: A paired t comparison between paired scaphoids and capitates showed no difference between the trabecular bone densities. However, their total bone and cortical densities were found to be different. An independent measures ANOVA comparison of the five bones, showed no significant difference in mean trabecular density between the capitates, naviculars and first cuneiforms when compared to the scaphoids. However, the mean total and cortical densities of the first cuneiforms were less than the scaphoids and the mean trabecular, total and cortical bone densities of the cuboids were all less than the scaphoids. DISCUSSION: Compression fracture fixation studies of headless compression screws could be conducted using the capitate, navicular, and first cuneiform as models of the scaphoid when the supply of scaphoids is limited.

Aged↗
PubMed1996

Clinically suspected scaphoid fracture: a comparison of magnetic resonance imaging and bone scintigraphy.

59 patients with clinical suspicion of scaphoid fracture, but negative radiographs at presentation and review, were examined by magnetic resonance imaging (MRI) and bone scintigraphy (BS). The diagnoses were compared with subsequent follow-up. There were four scaphoid fractures, 10 other fractures and three significant ligamentous injuries. All scaphoid fractures were identified by MRI and BS. MRI showed better interobserver agreement for scaphoid injury than BS and fewer false positive reports. Significant ligamentous injury and carpal instability diagnosed by MRI were not evident on scintigraphy. Using fast scanning protocols, the cost of MRI is comparable with that of BS. MRI should be considered as the appropriate second line investigation in these clinical circumstances.

Adolescent↗
PubMed1988

Carpal alignment after different surgical approaches to the scaphoid: a comparative study.

Thirty-seven patients with inlay bone grafting for scaphoid nonunion were evaluated before and after operation for wrist function and carpal alignment. There were 26 in whom a palmar approach had been used. The remaining 11 had been treated with a dorsal approach. The two procedures showed a similar union rate (around 80%). The palmar approach, however, caused a significant increase in the scapholunate angle (p less than 0.001) and in the lunocapitate angle (p less than 0.05) and consequently augmented carpal collapse. The dorsal approach did not affect carpal alignment. The surgical division of the palmar radiocarpal ligaments, which is necessary when using a palmar approach, may be responsible for these findings. Accordingly, a dorsal approach should be preferable to a palmar approach when a graft is used for treatment of a scaphoid nonunion.

Adolescent↗
PubMed1992

Proximal and distal oblique radiography of the wrist: value in occult injuries.

Fractures of the scaphoid and capitate bones are frequently nondisplaced at the initial examination. In addition, obliquity of the fracture line may result in the fracture not being profiled on routine views. Angling the radiographic tube 30 degrees off the vertical toward the elbow results in elongation of the scaphoid and capitate bones and improves visualization of the scaphoid over routine posteroanterior radiographs. Reversing the angle of the tube to 30 degrees from the vertical toward the fingertips further elongates the capitate. This is useful for delineating occult fractures of the capitate.

False Negative Reactions↗