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Radiographic analysis of anatomic risk factors for scaphoid fractures; A case-control study

      Highlights

      • Scaphoid fractures may remain occult in the initial radiographic examination.
      • Identification of anatomic risk factors may help to detect scaphoid fractures.
      • Increased radiographic indices of distal radius are risk factors for scaphoid fractures.
      • Negative ulnar variance is an anatomic risk factor for scaphoid fractures.

      Abstract

      Aim

      The purpose of this study was to investigate the role of anatomic variations in distal radius radiographic indices in patients with or without scaphoid fractures.

      Materials and methods

      Radial inclination (RI), volar tilt (VT), radial height (RH) and ulnar variance (UV) were measured on wrist radiographs of 320 patients with (Group I, n = 167) or without (Group II, n = 153) scaphoid fracture, fall on outstretched hand (FOOSH). Receiver operating characteristics (ROC) curve analysis was used to assess the diagnostic performance for each variable. Sensitivity (Sn), specificity (Sp), cutoff value, and area under the ROC curve were analyzed. Odds ratio was calculated for defined cutoff values.

      Results

      The mean age of the groups was similar (29.3 ± 10.2 vs 31.1 ± 9.9 years, p = 0.060). RI (30.0 ± 2.9 vs 26.8 ± 2.3°) VT (11.4 ± 2.4 vs 10.5 ± 2.2°), RH (14.8 ± 2.1 vs 13.2 ± 1.9 mm), UV (−0.46 ± 1.7 vs 0.00 ± 1.5 mm) were higher in scaphoid fracture group (Gr I vs Gr II, p = 0.000, p = 0.000, p = 0.001, p = 0.012 respectively). Ulna minus variant was more prevalent in fracture group (p = 0.001). Optimal cutoff points for RI, VT, RH and UV in differentiating fractured and intact scaphoid were 28.6° (Sn = 81.0%, Sp = 26.3%), 12.2° (Sn = 80.4%, Sp = 67.1%), 14.85 mm (Sn = 80.4%, Sp = 52.1%) and 0 mm (Sn = 88.6%, Sp = 75.8%), respectively. Odds ratios for defined cutoff points for RI, VT, RH and UV were 10.4 (95% CI, 6.2–17.4), 1.8 (95% CI, 1.1–3.0), 3.7 (95% CI, 2.3–6.2) and 2.2 (95% CI, 1.3–3.7) respectively.

      Conclusion

      Increased RI, VT, RH and negative UV were found to be predisposing anatomical risk factors for scaphoid fracture when FOOSH.

      Keywords

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      References

        • Van Tassel D.C.
        • Owens B.D.
        • Wolf J.M.
        Incidence estimates and demographics of scaphoid fracture in the U.S. population.
        J Hand Surg [Am]. 2010; 35: 1242-1245https://doi.org/10.1016/j.jhsa.2010.05.017
        • Weber E.R.
        • Chao E.Y.
        An experimental approach to the mechanism of scaphoid waist fractures.
        J Hand Surg [Am]. 1978; 3: 142-148
        • Horii E.
        • Nakamura R.
        • Watanabe K.
        • Tsunoda K.
        Scaphoid fracture as a “puncher's fracture”.
        J Orthop Trauma. 1994; 8: 107-110
        • Mayfield J.K.
        • Johnson R.P.
        • Kilcoyne R.K.
        Carpal dislocations: pathomechanics and progressive perilunar instability.
        J Hand Surg [Am]. 1980; 5: 226-241
        • Genda E.
        • Horii E.
        Theoretical stress analysis in wrist joint—neutral position and functional position.
        J Hand Surg (Br). 2000; 25: 292-295https://doi.org/10.1054/jhsb.2000.0388
        • Hara T.
        • Horii E.
        • An K.N.
        • Cooney W.P.
        • Linscheid R.L.
        • Chao E.Y.
        Force distribution across wrist joint: application of pressure-sensitive conductive rubber.
        J Hand Surg [Am]. 1992; 17: 339-347
      1. Palmer AK, Werner FW. Biomechanics of the distal radioulnar joint. Clin Orthop Relat Res n.d.:26–35.

        • Majima M.
        • Horii E.
        • Matsuki H.
        • Hirata H.
        • Genda E.
        Load transmission through the wrist in the extended position.
        J Hand Surg [Am]. 2008; 33: 182-188https://doi.org/10.1016/j.jhsa.2007.10.018
        • Ramos-Escalona J.
        • García-Bordes L.
        • Martínez-Galarza P.
        • Yunta-Gallo A.
        Ulnar variance and scaphoid fracture.
        J Hand Surg Eur Vol. 2010; 35: 195-197https://doi.org/10.1177/1753193409352281
        • Langhoff O.
        • Andersen J.L.
        Consequences of late immobilization of scaphoid fractures.
        J Hand Surg (Br). 1988; 13: 77-79
        • Brydie A.
        • Raby N.
        Early MRI in the management of clinical scaphoid fracture.
        Br J Radiol. 2003; 76: 296-300https://doi.org/10.1259/bjr/19790905
        • Fowler C.
        • Sullivan B.
        • Williams L.A.
        • McCarthy G.
        • Savage R.
        • Palmer A.
        A comparison of bone scintigraphy and MRI in the early diagnosis of the occult scaphoid waist fracture.
        Skeletal Radiol. 1998; 27: 683-687
        • Yin Z.-G.
        • Zhang J.-B.
        • Kan S.-L.
        • Wang X.-G.
        Diagnosing suspected scaphoid fractures: a systematic review and meta-analysis.
        Clin Orthop Relat Res. 2010; 468: 723-734https://doi.org/10.1007/s11999-009-1081-6
        • Ilica T.
        • Ozyurek S.
        • Kose O.
        • Durusu M.
        Multi-detector CT in the early diagnosis of occult scaphoid fractures.
        Jpn J Radiol. 2011; 29: 98-103
        • Young M.R.
        • Lowry J.H.
        • McLeod N.W.
        • Crone R.S.
        Clinical carpal scaphoid injuries.
        Br Med J (Clin Res Ed). 1988; 296: 825-826
        • Adey L.
        • Souer J.S.
        • Lozano-Calderon S.
        • Palmer W.
        • Lee S.-G.
        • Ring D.
        Computed tomography of suspected scaphoid fractures.
        J Hand Surg [Am]. 2007; 32: 61-66https://doi.org/10.1016/j.jhsa.2006.10.009
        • Staniforth P.
        Scaphoid fractures and wrist pain—time for new thinking.
        Injury. 1991; 22: 435-436
        • Dorsay T.A.
        • Major N.M.
        • Helms C.A.
        Cost-effectiveness of immediate MR imaging versus traditional follow-up for revealing radiographically occult scaphoid fractures.
        AJR Am J Roentgenol. 2001; 177: 1257-1263https://doi.org/10.2214/ajr.177.6.1771257
        • Schuind F.A.
        • Linscheid R.L.
        • An K.N.
        • Chao E.Y.
        A normal data base of posteroanterior roentgenographic measurements of the wrist.
        J Bone Joint Surg Am. 1992; 74: 1418-1429
        • Jedlinski A.
        • Kauer J.M.
        • Jonsson K.
        X-ray evaluation of the true neutral position of the wrist: the groove for extensor carpi ulnaris as a landmark.
        J Hand Surg [Am]. 1995; 20: 511-512https://doi.org/10.1016/S0363-5023(05)80120-0
        • Levis C.M.
        • Yang Z.
        • Gilula L.A.
        Validation of the extensor carpi ulnaris groove as a predictor for the recognition of standard posteroanterior radiographs of the wrist.
        J Hand Surg [Am]. 2002; 27: 252-257
        • Cooney W.P.
        • Dobyns J.H.
        • Linscheid R.L.
        Fractures of the scaphoid: a rational approach to management.
        Clin Orthop Relat Res. 1980; : 90-97
        • Lachin J.M.
        The role of measurement reliability in clinical trials.
        Clin Trials. 2004; 1: 553-566https://doi.org/10.1191/1740774504cn057oa
        • Cockshott W.P.
        Distal avulsion fractures of the scaphoid.
        Br J Radiol. 1980; 53: 1037-1040https://doi.org/10.1259/0007-1285-53-635-1037
        • Ball L.
        • Ferran N.A.
        • Barton C.R.
        Scaphoid fracture due to rigid handcuffs.
        J Hand Surg Eur Vol. 2008; 33: 484-487https://doi.org/10.1177/1753193408089055
        • Sutton P.A.
        • Clifford O.
        • Davis T.R.C.
        A new mechanism of injury for scaphoid fractures: “test your strength” punch-bag machines.
        J Hand Surg Eur Vol. 2010; 35: 419-420https://doi.org/10.1177/1753193409352713
        • Brutus J.P.
        • Chahidi N.
        Could this unusual scaphoid fracture occurring in a badminton player be a stress fracture?.
        Chir Main. 2004; 23: 52-54
        • Mason J.S.
        • Crowell M.S.
        • Goss D.L.
        Fracture of the scaphoid during a bench-press exercise.
        J Orthop Sports Phys Ther. 2015; 45: 642https://doi.org/10.2519/jospt.2015.0408
        • Tsuge S.
        • Nakamura R.
        Anatomical risk factors for Kienböck's disease.
        J Hand Surg (Br). 1993; 18: 70-75
        • Jafari D.
        • Shariatzadeh H.
        • Mazhar F.N.
        • Ghahremani M.H.
        • Jalili A.
        Radial inclination and palmar tilt as risk factors for Kienböck's disease.
        Am J Orthop (Belle Mead NJ). 2012; 41: E145-E146
        • Thienpont E.
        • Mulier T.
        • De Smet L.
        Radiographic analysis of anatomic risk factors for scapholunate dissociation.
        Acta Orthop Belg. 2003; 69: 246-251
        • Jafari D.
        • Shariatzadeh H.
        • Najd Mazhar F.
        • Ghahremani M.H.
        Ulnar variance in scaphoid nonunion.
        Arch Iran Med. 2013; 16: 301-302