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Can Computerized Tomography be Used to Predict Successful Non-Operative Treatment of Scaphoid Waist Fractures?
Ruby Grewal, MD, MSc, FRCSC; Nina Suh, MD, FRCSC; Joy MacDermid, BScPT, PhD
Roth|MacFarlane Hand and Upper Limb Centre, University of Western Ontario, London, ON, Canada

Introduction: The purpose of this study was to determine whether computerized tomography (CT) could be used to predict success with non-operative treatment of scaphoid fractures and to determine if any predictors for delayed union could be identified.

Materials and methods: A radiology data base (2004-2013) was searched to identify a cohort of simple acute scaphoid waist fractures. Simple waist fractures were identified by excluding cases presenting >6 weeks from injury, or those with CT findings associated with nonunion/delayed union (displacement, humpback deformity, comminution and/or a sclerotic border). Cases that were not given a trial of non-operative management were excluded (n=23). The x-rays, CT scans and health records for each patient were reviewed to extract data on the injury, treatment course and outcome.

Results: A sample of 164 patients met inclusion criteria (133 males, 31 females). The mean age was 30 16 years. Five patients had diabetes, 78 were smokers (47.5%), 36 were non-smokers (22.0%) and the smoking status was unknown in 50 patients (30.5%). Although all fractures were acute, 17 patients had evidence of cystic resorption along the fracture line on CT.

The union rate for this cohort of simple non-operatively treated scaphoid fractures was 99. 4 (1 nonunion/164 subjects). The mean time to union was approximately 7.5 weeks (53 38 days). Smoking did not affect union rates (p=0.17) or time to union (p=0.9), nor did energy of injury, age, gender, diabetes. Cysts did not affect the non-union rate (p=0.73) but patients with cystic resorption along the fracture line required approximately 10 weeks for union (70.6 61.2 days) compared to 7 weeks (50.9 34.2 days) for those without cysts (p=0.04). A small percentage of patients required casting for greater than 3 months to achieve union (8%), with 4.9% requiring casting for greater than 4 months. There was a correlation between the number of days before the fracture was casted and the length of time needed to achieve union (r=0.27, p=0.001), however, once casted, the treatment delay was not correlated with a longer time to union (r=0.062, p=0.43) indicating that once treatment was initiated, the delay did not adversely affect union times.
Conclusions: Using CT to assess scaphoid fractures can help identify scaphoid fractures that can be expected to heal reliably (99.4%) within a short time frame (7 weeks), allowing us to focus operative resources on those with a higher likelihood of delayed union or progression to non-union.

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