Article
Scaphoid Fracture Classification: A Three-Dimensional Computed Tomography Analysis
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Authors
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Anne Eva Bulstra
- Flinders Medical Centre, Flinders University, University of Amsterdam, Bedford Park, Australia
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Arthur Turow
- Flinders Medical Centre, Bedford Park, Australia
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Miriam Oldhoff
- Delf University of Technology, Delft, Netherlands
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Batur Hayat
- Flinders Medical Centre, Flinders University, University of Amsterdam, Bedford Park, Australia
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Job Doornberg
- Flinders Medical Centre, Bedford Park, Australia
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Gregory Bain
- Flinders Medical Centre, Bedford Park, Australia
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: Traditional scaphoid fracture classifications rely on radiography. Radiography alone can prove challenging for fracture diagnosis and description of fracture characteristics. The aims of this study were to describe acute fracture morphology, to map fracture patterns onto a three-dimensional scaphoid model and to devise a classification system based on computed tomography (CT).
Methods: In this retrospective, multicenter study, 59 adult (>18yrs) patients with an acute scaphoid fracture who had a CT-scan within 6 weeks after injury were included for analysis. Exclusions: pre-existing scaphoid pathology and scans of insufficient quality (such as slice thickness >2mm). CT scans were segmented manually to create 3D surface rendered models. These models were reduced and superimposed onto a 3D standardised template of an intact scaphoid. Fracture lines of all models were then superimposed onto the template.
Results: Preliminary analysis identified four distinct fracture patterns:
- 1.
- Proximal pole: 17% of the fractures ran obliquely and proximal to the dorsal ridge. These fractures were more distal than usually described.
- 2.
- Transverse waist: 29% of the fractures fractured transversely through the dorsal ridge
- 3.
- Oblique waist: 37% of the fractures ran obliquely along the dorsal ridge
- 4.
- Scaphoid tubercle fracture: 17% of the fractures constituted 2 types of tubercle fractures - those localised to the Scapho-Trapezial ligaments, and those that went into the STT joint.
The proximal pole and scaphoid tubercle fractures were rarely significantly displaced. Waist fractures were commonly displaced (31%). Most fractures were 2-part fractures (92%). Remaining fractures (8%) were 3-part fractures, which typically involved displaced oblique waist fractures with a third fragment involving the dorsal ridge (Figure 1 [Fig. 1]).
Conclusion: 3D-CT analysis identified four distinct patterns of scaphoid fractures: proximal pole fractures, transverse waist fractures, oblique waist fractures and tubercle fractures. Waist fractures were commonly significantly displaced, whereas proximal pole and tubercle fractures were not.
