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Scaphoid Fracture

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3. Clinical and cost implications of using immediate MRI in the management of patients with a suspected scaphoid fracture and negative radiographs results from the SMaRT trial Full Text available with Trip Pro

Clinical and cost implications of using immediate MRI in the management of patients with a suspected scaphoid fracture and negative radiographs results from the SMaRT trial 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

2019 EvidenceUpdates

4. What Physical Examination Findings and Diagnostic Imaging Modalities Are Most Useful in the Diagnosis of Scaphoid Fractures?

What Physical Examination Findings and Diagnostic Imaging Modalities Are Most Useful in the Diagnosis of Scaphoid Fractures? Systematic Review Snapshot TAKE-HOME MESSAGE Whenapatientwithacutewristpainisevaluated,theabsenceofsnuffboxtenderness substantiallydecreasestheprobabilityofascaphoidfracture.Alternatively,to de?nitivelydiagnoseascaphoidfracture,advancedimagingsuchascomputed tomography(CT)ormagneticresonanceimaging(MRI)maybenecessary. What Physical Examination Findings and Diagnostic (...) Imaging Modalities Are Most UsefulintheDiagnosisofScaphoidFractures? EBEM Commentators Seth Gemme, MD Robert Tubbs, MD Department of Emergency Medicine The Alpert Medical School of Brown University Providence, RI Results A total of 957 unique citations were found, with 75 primary studies included in the systematic review. In theemergency department (ED)–based studies, 1 of 4 patients presenting with persistent wrist pain, suspicion for scaphoid fracture, and an initial nega- tive radiograph result

2015 Annals of Emergency Medicine Systematic Review Snapshots

5. The Effect of Computed Tomography Scans Oriented Along the Longitudinal Scaphoid Axis on Measurements of Deformity and Displacement in Scaphoid Fractures. (Abstract)

The Effect of Computed Tomography Scans Oriented Along the Longitudinal Scaphoid Axis on Measurements of Deformity and Displacement in Scaphoid Fractures. Reformatting computed tomography (CT) scans along the scaphoid longitudinal axis improves the ability to detect scaphoid fractures compared with reformats along the wrist axis. However, it remains unclear whether scaphoid axis reformats affect measurements of displacement or deformity, which are factors that drive the clinical decision (...) to perform open reduction internal fixation. Our null hypothesis was that reformatting CT scans along the scaphoid axis does not affect measurements of fracture displacement and deformity.Thirty patients with CT scans demonstrating scaphoid fractures (4 proximal pole, 17 midwaist fractures, and 9 distal) were identified and reformatted along 2 axes: the longitudinal axis of the scaphoid and the longitudinal axis of the wrist. The reformatted scans were sent to 2 musculoskeletal radiologists and 2

2018 Journal of Hand Surgery - American

6. Disability and return to work after MRI on suspicion of scaphoid fracture: Influence of MRI pathology and occupational mechanical exposures. Full Text available with Trip Pro

Disability and return to work after MRI on suspicion of scaphoid fracture: Influence of MRI pathology and occupational mechanical exposures. We aimed to determine the prognosis after early MRI on clinical suspicion of scaphoid fracture, hypothesising that MRI pathology is associated with more disability and that MRI pathology and high occupational mechanical hand-arm exposures are associated with slower return to work (RTW).We conducted a follow-up study of a cohort of 469 patients, who were

2018 PLoS ONE

7. Optoelectronic measurement of wrist movements in various casts and orthoses used in scaphoid fractures. Full Text available with Trip Pro

Optoelectronic measurement of wrist movements in various casts and orthoses used in scaphoid fractures. We developed an optoelectronic motion analysis protocol to measure anatomical and functional ranges of wrist motion in Colles'-type and scaphoid-type splints and casts. The protocol was used to study the restriction of wrist motion in casts and splints in ten healthy volunteers. Scaphoid-type casts were no more restrictive to wrist motion than Colles'-type casts, but casts were significantly (...) more restrictive than removable splints. Removable splints were more restrictive than no immobilization. Results suggest there is no benefit in using scaphoid-type casts rather than Colles'-type casts to reduce wrist motion.

2019 Journal of Hand Surgery - European

8. Why scaphoid fractures are missed. A review of 52 medical negligence cases. (Abstract)

Why scaphoid fractures are missed. A review of 52 medical negligence cases. The "missed" scaphoid fracture is a common cause of litigation. This study investigates why a series of scaphoid fractures involved in medical negligence litigation were missed. It also assesses how many might have been detected if MRI had been used to assess all suspected scaphoid fractures with normal X-rays, as suggested by National Institute for Health and Care Excellence (NICE).Medical reports on 52 medical (...) negligence cases of missed scaphoid fractures were reviewed. Complete sets of hospital and GP records and X-rays had been reviewed in every case.The recorded mechanism of injury was consistent with a scaphoid fracture in 41 (79%) cases. There was no record of an examination for scaphoid tenderness in 37 (71%) cases. Scaphoid tenderness was assessed and not found in 10 of 15 cases. No X-rays were obtained in 13 (25%) cases, and a scaphoid fracture was only suspected, resulting in scaphoid series X-rays

2019 Injury

9. Comparison of SCAphoid fracture osteosynthesis by MAGnesium-based headless Herbert screws with titanium Herbert screws: protocol for the randomized controlled SCAMAG clinical trial. Full Text available with Trip Pro

Comparison of SCAphoid fracture osteosynthesis by MAGnesium-based headless Herbert screws with titanium Herbert screws: protocol for the randomized controlled SCAMAG clinical trial. Scaphoid fractures are the most common carpal fractures. They often need to be treated by surgery, where the use of a compression screw is the globally accepted gold standard. Surgeons may choose between different implant materials including titanium alloys, which remain in the body or are removed after healing (...) patients will be randomized (1:1) with stratification by center either to titanium or magnesium-based compression screws. Follow-up is 1 year per patient. Surgical procedures and aftercare will be performed according to the German treatment guideline for scaphoid fractures. The first primary endpoint is the patient-rated wrist evaluation (PRWE) score after 6 months. The second primary endpoint is a composite safety endpoint including bone union until 6 months, no adverse device effect (ADE) during

2019 BMC Musculoskeletal Disorders Controlled trial quality: predicted high

10. The outcome of bone graft surgery for nonunion of fractures of the scaphoid. Full Text available with Trip Pro

The outcome of bone graft surgery for nonunion of fractures of the scaphoid. Data on 806 patients undergoing bone graft surgery for a scaphoid fracture nonunion were retrospectively collected at 19 centres in the United Kingdom. Each centre contributed at least 30 cases. Sufficient data were available in 462 cases to study factors that influenced the outcome of surgery. Overall union occurred in at least 69%, and nonunion in at least 22%, with 9% of cases having 'uncertain union status'. Union (...) appeared to be adversely influenced by smoking and the time between acute scaphoid fracture and nonunion surgery, with adjusted odds ratios of 1.8 and 2.4, respectively, but neither achieved the pre-determined significance level of 0.003. The type of bone graft (vascular vs non-vascular; iliac crest vs distal radius) did not appear to influence outcome. Further large multicentre prospective studies with clear definitions of 'union' and other factors are needed to clarify whether modification

2019 Journal of Hand Surgery - European

11. Robot-assisted percutaneous scaphoid fracture fixation: a report of ten patients. (Abstract)

Robot-assisted percutaneous scaphoid fracture fixation: a report of ten patients. This study reports the technique, efficacy and safety of robotic-assisted, computer-navigated, percutaneous fixation of scaphoid fractures. Ten males with acute undisplaced waist fractures underwent fixation with this method using a commercially available three-dimensional fluoroscopy unit and robotic navigation system. The mean total operative duration was 40 minutes, which comprised of a set-up time of 18 (...) minutes and planning and surgical time of 22 minutes. All patients required only a single guidewire insertion attempt, and there were no screw protuberances or other complications. All fractures united at a mean of 8 weeks. At a mean follow-up of 6.5 months (range 6-8), the mean Mayo wrist score was 96, patient-rated wrist evaluation was 2, flexion-extension arc was 96% and grip strength was 91% of the contralateral side. We conclude from our patients that robotic-assisted percutaneous scaphoid

2019 Journal of Hand Surgery - European

12. The epidemiology of scaphoid fractures in Sweden: a nationwide registry study. (Abstract)

The epidemiology of scaphoid fractures in Sweden: a nationwide registry study. The epidemiology of scaphoid fractures has been described in limited populations, and incidence reports have been inconsistent. We investigated the nationwide incidence of scaphoid fractures by evaluating data on 34,377 patients in the Swedish National Patient Register for the years 2006-2015 regarding diagnosis, age, sex and treatment. The data were validated in 300 random patients, and incidence rates were adjusted (...) accordingly. Forty-one per cent of the initially diagnosed fractures were false positives. The adjusted true fracture incidence rate was 22 per 100,000 person-years. During the decade studied incidence rates decreased in younger men and increased in middle-aged women. The incidence of surgical treatment vs. non-operative treatment did not change over time. Men were treated surgically more often than women (6% vs. 3%) and had a greater risk for nonunion (3% vs. 1%).

2019 Journal of Hand Surgery - European

13. Three-dimensional-printed patient-specific Kirschner-wire guide for percutaneous fixation of undisplaced scaphoid fractures: a cadaveric study. (Abstract)

Three-dimensional-printed patient-specific Kirschner-wire guide for percutaneous fixation of undisplaced scaphoid fractures: a cadaveric study. Undisplaced scaphoid waist fractures can be managed by percutaneous fixation. The purpose of this study is to compare percutaneous fixation using a three-dimensional (3-D)-printed guide with the conventional method in a cadaveric study. Twelve wrists were divided into two groups: standard fluroscopic technique group, and a patient-specific 3-D-printed (...) guide group. In the patient-specific group, using high resolution CT scans, we manufactured a mould-guide including a wire guide sleeve aligned with the planned ideal path, and 3-D printed it. On postoperative CT scans we measured the angular deviation of the screw axis from the ideal axis, and compared the two groups. The angular deviation was significantly lower in the patient-specific guide group. We concluded that a 3-D-printed guide for scaphoid percutaneous fixation allows a more accurate

2019 Journal of Hand Surgery - European

14. Scaphoid waist fractures fixation with staple. Retrospective study of a not widespread procedure. (Abstract)

Scaphoid waist fractures fixation with staple. Retrospective study of a not widespread procedure. In carpal scaphoid fractures, the surgical treatment with screw is considered the gold standard; shape memory staple however presents substantial advantages. The authors report a study on unstable fractures of the scaphoid waist (type B1, B2, B5, according to Herbert classification) treated with shape memory staple on a large sample of patients, with the aim to confirm the usefulness of this method (...) , the quality of reduction and fixation, the functional results, the time of union and the possible complications.A retrospective analysis of 131 patients with scaphoid waist fractures with minimum follow-up 1 year was performed. Staples were used in all cases; technical details are discussed. Outcome measures were: postoperative pain, flexion-extension wrist range, hand grip strength, radiographic consolidation, work absence. Herbert and Fisher Grading System was used to assess subjective, objective

2019 Injury

15. Three-Dimensional Analysis of Acute Scaphoid Fracture Displacement: Proximal Extension Deformity of the Scaphoid. (Abstract)

Three-Dimensional Analysis of Acute Scaphoid Fracture Displacement: Proximal Extension Deformity of the Scaphoid. Our goal was to analyze the movement of acute scaphoid waist fracture fragments and adjacent bones in a common coordinate system. Our hypothesis was that the distal scaphoid fragment flexes and pronates and the proximal fragment extends.Computed tomography (CT) scans of patients diagnosed with an acute scaphoid waist fracture were evaluated using a 3-dimensional (3D) model (...) . The scans of 57 nondisplaced and 23 displaced fractures were compared with a control group of 27 scans showing no pathological involvement of the wrist. Three anatomical landmarks were labeled on the distal and proximal fragments of the scaphoid, the lunate, and the trapezium. Each set of labels formed a triangle representing the bone or fragment. Four landmarks were labeled on the distal radial articular surface and used to create a common coordinate system. The position of each bone or fragment

2017 The Journal of Bone and Joint Surgery. American Volume

16. In Vivo Scaphoid Motion During Thumb and Forearm Motion in Casts for Scaphoid Fractures. (Abstract)

In Vivo Scaphoid Motion During Thumb and Forearm Motion in Casts for Scaphoid Fractures. In nonsurgical treatment for acute undisplaced or minimally displaced scaphoid waist fractures, immobilization of both wrist and thumb can be an option. However, in vivo scaphoid motion during forearm and thumb motion with the wrist immobilized in a cast has not been measured. Therefore, we examined the in vivo kinematics of the scaphoid during forearm and thumb motion with cast immobilization.Ten healthy (...) , the scaphoid motion during forearm and thumb motion was not significant.Several high-quality studies have shown that undisplaced or minimally displaced scaphoid waist fractures can be successfully treated with casts. Movement of scaphoid and wrist during forearm rotation or thumb motion with a cast may not be sufficient to have a negative impact on the outcome of scaphoid fracture using a cast.Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

2017 Journal of Hand Surgery - American

17. Management of displaced fractures of the waist of the scaphoid: meta-analyses of comparative studies

Management of displaced fractures of the waist of the scaphoid: meta-analyses of comparative studies Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.

2012 DARE.

18. Rationale and design of the SMaRT trial: A randomised, prospective, parallel, non-blinded, one-centre trial to evaluate the use of magnetic resonance imaging in acute setting in patients presenting with suspected scaphoid fracture. (Abstract)

Rationale and design of the SMaRT trial: A randomised, prospective, parallel, non-blinded, one-centre trial to evaluate the use of magnetic resonance imaging in acute setting in patients presenting with suspected scaphoid fracture. Background Wrist injury is a common presentation to the Emergency Department in the United Kingdom. Among these injuries, the scaphoid is the most common fractured carpal bone. However, given the limited ability of conventional radiography to accurately diagnose (...) a suspected scaphoid fracture on presentation, its diagnosis and management remain challenging. Despite the vast clinical evidence supporting the superior accuracy of magnetic resonance imaging, there is little to no evidence around the real-world clinical and economic impact of immediate magnetic resonance imaging in the management of suspected scaphoid fractures. Methods Review of design and implementation challenges associated with the identification and subsequent recruitment of eligible patients

2018 Clinical trials (London, England)

19. The Use of Three-Dimensional Printing for Complex Scaphoid Fractures. (Abstract)

The Use of Three-Dimensional Printing for Complex Scaphoid Fractures. Scaphoid fractures are one of the most common fractures treated by hand surgeons. The complex anatomy and size of the scaphoid bone can make the reduction and fixation of these fractures technically challenging. Careful preoperative planning is required to ensure stable fixation is achieved. We report on the use of 3-dimensional printing to improve preoperative planning for a series of complex scaphoid fractures.Copyright ©

2018 Journal of Hand Surgery - American

20. Conservative treatment of a pathologic fracture of the scaphoid bone in a child: A case report. Full Text available with Trip Pro

Conservative treatment of a pathologic fracture of the scaphoid bone in a child: A case report. Tumors of the scaphoid are rare, and some can cause pathological fractures. No cases of pathological fractures of the scaphoid have been reported in children. The most common treatment for pathologic fractures of the scaphoid bone associated with a benign lesion in adults is surgical, with intralesional curettage associated with autologous bone grafting and internal fixation.A 10-year-old boy (...) presented with wrist pain after falling from his height.X-ray, CT-scan and MRI showed a pathological undisplaced fracture of the scaphoid on a benign lytic lesion.The arm was immobilized in a below-elbow cast.The fracture healed within 4 months of immobilization. 3 years after the fracture, the functional status was normal, and the lytic lesion could not be seen on radiographs.Retrospectively, the most probable etiology was a ganglion cyst. Our case suggests that some pathological fractures

2018 Medicine

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