How is Scaphoid Malunion Defined: A Systematic Review
Michelle Xiao, BS1, Jessica M Welch, BS2, Samuel A Cohen, BS1, Robin N Kamal, MD1 and Lauren Michelle Shapiro, MD1, (1)Stanford University, Redwood City, CA, (2)Stanford, Redwood City, CA
Background: Abnormal scaphoid alignment after fracture is used as an indication for fixation. Acceptable alignment after reduction and fixation of scaphoid fractures is not well defined. We systematically reviewed the literature to identify how scaphoid malunion is currently defined and by what parameters.
Methods: A systematic review was performed using the PRISMA guidelines. Multiple databases were searched for studies published in the English language that reported on outcomes after scaphoid malunion and included measurements to define malunions. Radiographic scaphoid measurement parameters were collected. Clinical outcome measures recorded included grip strength, wrist range of motion, and patient reported outcome measures. Study quality was analyzed using MINORS criteria. Descriptive summaries of the studies are presented.
Results: The initial search yielded 1600 articles. Ten articles (161 subjects, 93% males, mean age 28.3+6.3 years, mean MINORS score 10.2+1.6) were included and analyzed. Scaphoid malunion was defined if the lateral intrascaphoid angle (LISA) was >45 ̊ (three articles), LISA >35 ̊ (one article), and height to length (H/L) ratio >0.6 (three articles). Four out of five studies found no significant associations between patient outcomes and degree of scaphoid malunion measured on imaging.
Conclusions: There is a lack of consensus for defining scaphoid malunion on imaging and absence of correlation between findings on imaging and patient outcomes. Future studies defining scaphoid malunion should be appropriately powered, incorporate measures of intra- and inter-rater reliability for all reported imaging measurements, and utilize validated patient reported outcome measures to reflect that malunion is associated with inferior outcomes meaningful to patients.
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