The rate of nonunion in the MRI-detected occult scaphoid fracture
Author
Dean, Benjamin J FRiley, Nicholas
Little, Christopher
Sheehan, Warren
Gidwani, Sam
Brewster, Mark
Dhiman, Paula
Costa, Matt L
Publication date
2024-04-01Subject
Orthopaedics
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Aims: 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. Methods: 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. Results: 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). Conclusion: 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.Citation
Dean BJF, Riley N, Little C, Sheehan W, Gidwani S, Brewster M, Dhiman P, Costa ML. The rate of nonunion in the MRI-detected occult scaphoid fracture. Bone Joint J. 2024 Apr 1;106-B(4):387-393. doi: 10.1302/0301-620X.106B4.BJJ-2023-1171.R1.Type
ArticleOther
Additional Links
https://online.boneandjoint.org.uk/?journalCode=bjjPMID
38555933Journal
The Bone & Joint Journalae974a485f413a2113503eed53cd6c53
10.1302/0301-620X.106B4.BJJ-2023-1171.R1