Importance of Computed Tomography in Determining Displacement of Scaphoid Fractures: N/A - Not a clinical study

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Hypothesis

Scaphoid fracture displacement has been shown to correlate with higher risk of nonunion. We reviewed images from scaphoid fractures to determine if computed tomography (CT) changed the diagnosis of displacement compared to plain radiography.

Methods

Thirty-nine pre-operative radiographs and CT scans were evaluated by two blinded observers. Measurements of displacement and angular deformity were recorded. The readers were asked to judge the fracture as displaced or nondisplaced. A displaced fracture was defined as having >1 millimeter of displacement between cortices. Scapholunate, radiolunate, and intrascaphoid angles were measured. Independent samples t-tests were used to assess radiographic measures of fractures that were read

Results

Reader one identified 13 fractures (33%) as displaced on radiographs, and 26 (67%) as displaced on CT scan. Thirteen fractures were recorded as nondisplaced on radiograph, but displaced on CT scan (33%). (Figure 1) Reader two identified 16 fractures (41%) as displaced on radiograph, and 26 (67%) displaced on CT scan. Ten fractures were reported, by Reader two, as nondisplaced on radiograph, but displaced on CT scan (26%). Interobserver reliability for diagnosing displacement on radiograph was

Summary Points

  • 26-33% of scaphoid fractures were judged nondisplaced on radiograph, but displaced on CT scan.

  • Recognizing displacement and deformity is important when deciding on surgical intervention, as it may alter the treatment and surgical approach to the fracture. For this reason, we recommend CT scan to evaluate all scaphoid fractures.

  • Although interobserver reliability between readers on radiographs was substantial (73%), the reliability between readers on CT scan was perfect (100%). Amongst different

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