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Radiographic Findings of Isolated Scaphoid Fractures Compared to Trans-scaphoid Perilunate Fractures
Jennifer Schklair Kargel, MD1; Oded Ben-Amotz, MD2; Douglas M. Sammer, MD1; Robert Bass, MD1
1University of Texas Southwestern Medical Center, Dallas, TX, 2Penn Musculoskeletal Center, Philadelphia, PA
Introduction: The scaphoid is the most commonly fractured carpal bone. Although scaphoid fractures are usually an isolated injury, they can also present as a component of a more complex injury, the trans-scaphoid perilunate dislocation. Radiographic findings such as the location of the fracture within the scaphoid, and the degree of comminution are important prognostic indicators. The purpose of this study is to compare the radiographic characteristics of isolated scaphoid fractures with those of scaphoid fractures that occur in the setting of a trans-scaphoid perilunate dislocation.
Methods: A retrospective review was performed of all scaphoid fractures that presented to a single institution during a 5 year period. Patient demographics and injury mechanism and characteristics were recorded. Radiographic measurements were made, including the location of the fracture within the scaphoid, and the presence and degree of comminution.
Results: 137 patients (139 wrists) were identified. 113 patients had isolated scaphoid fractures, and 26 had trans-scaphoid perilunate fracture dislocations. Demographic and injury characteristics for the two groups were similar. The average fracture location was more proximal in trans-scaphoid perilunate dislocations than in isolated scaphoid fractures (scaphoid fracture location ratio of 0.48 versus 0.54, p=0.037, one-way ANOVA). The distribution of fractures in the proximal and middle thirds was similar for the two groups. However, fractures occurred in the distal third of the scaphoid in 12% of isolated fractures, compared to 0% of trans-scaphoid perilunate dislocations. 9% of isolated scaphoid fractures demonstrated comminution, compared to 12% of trans-scaphoid perilunate dislocations. The extent of comminution was 16% in isolated fractures, and 28% in trans-scaphoid perilunate dislocations. These differences were not significant.
Conclusion: Scaphoid fractures that occur in a trans-scaphoid perilunate fracture-dislocation tend to be more proximal in location than isolated scaphoid fractures. This may have important implications for union rate, and time to union.
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