The rate of nonunion in the MRI-detected occult scaphoid fracture: a multicentre cohort study
<p><b>Aims</b></p> 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....
| Principais autores: | , , , , , , , |
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| Formato: | Journal article |
| Idioma: | English |
| Publicado em: |
British Editorial Society of Bone and Joint Surgery
2024
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| _version_ | 1826312774236504064 |
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| author | Dean, BJF Riley, N Little, C Sheehan, W Gidwani, S Brewster, M Dhiman, P Costa, ML |
| author_facet | Dean, BJF Riley, N Little, C Sheehan, W Gidwani, S Brewster, M Dhiman, P Costa, ML |
| author_sort | Dean, BJF |
| collection | OXFORD |
| description | <p><b>Aims</b></p>
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.
<p><b>Methods</b></p>
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.
<p><b>Results</b></p>
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).
<p><b>Conclusion</b></p>
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. |
| first_indexed | 2024-04-23T08:25:53Z |
| format | Journal article |
| id | oxford-uuid:80b825e9-1aec-4734-8f10-080e868b3514 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-04-23T08:25:53Z |
| publishDate | 2024 |
| publisher | British Editorial Society of Bone and Joint Surgery |
| record_format | dspace |
| spelling | oxford-uuid:80b825e9-1aec-4734-8f10-080e868b35142024-04-15T13:02:27ZThe rate of nonunion in the MRI-detected occult scaphoid fracture: a multicentre cohort studyJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:80b825e9-1aec-4734-8f10-080e868b3514EnglishSymplectic ElementsBritish Editorial Society of Bone and Joint Surgery2024Dean, BJFRiley, NLittle, CSheehan, WGidwani, SBrewster, MDhiman, PCosta, ML<p><b>Aims</b></p> 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. <p><b>Methods</b></p> 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. <p><b>Results</b></p> 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). <p><b>Conclusion</b></p> 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. |
| spellingShingle | 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: a multicentre cohort study |
| title | The rate of nonunion in the MRI-detected occult scaphoid fracture: a multicentre cohort study |
| title_full | The rate of nonunion in the MRI-detected occult scaphoid fracture: a multicentre cohort study |
| title_fullStr | The rate of nonunion in the MRI-detected occult scaphoid fracture: a multicentre cohort study |
| title_full_unstemmed | The rate of nonunion in the MRI-detected occult scaphoid fracture: a multicentre cohort study |
| title_short | The rate of nonunion in the MRI-detected occult scaphoid fracture: a multicentre cohort study |
| title_sort | rate of nonunion in the mri detected occult scaphoid fracture a multicentre cohort study |
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