Konstantin Holzapfel MD, Presenter: Nothing to Disclose

Klaus Werber, Abstract Co-Author: Nothing to Disclose

Ernst Josef Rummeny MD, Abstract Co-Author: Nothing to Disclose

Christian E.M. Hannig PhD, Abstract Co-Author: Nothing to Disclose

To evaluate the use of videofluoroscopy of the wrist for the differentiation of three types of scaphoid non-unions: (1) completely stable (fibrotic) scaphoid non-unions in which conservative treatment is possible, (2) partially stable (elastic fixation) and (3) completely instable scaphoid non-unions that require surgical intervention.

Videofluoroscopy was performed in 116 patients with non-union of the scaphoid bone demonstrated by plain radiographs. All patients performed the same maneuvers to ensure standardization of the examinations. After the forearm had been fixed in a neutral position, active and passive radio-ulnar movement of the wrist was recorded in anterioposterior (a. p.) view and active and passive dorso-palmar movement was recorded in a. p. and lateral projections. Total fluoroscopic time was 90-120 sec. Scaphoid non-union was considered stable when no movement between the fragments was observed. Partially stable scaphoid non-union was defined as varying distances of connected fragments during motion. In instable scaphoid non-union no functional connection during movement was seen. Images were analysed by an experienced radiologist in slow motion and frame-by-frame modus. Imaging findings obtained in wrist fluoroscopy were correlated with results of wrist arthroscopy and/or findings at surgery in all patients.

At arthroscopy and/or surgery 42 scaphoid non-unions were stable, 22 were partially stable and 52 were completely instable. Of the 42 non-unions considered stable, 41 were correctly classified by videofluoroscopy and only one was misclassified as partially stable resulting in a positive predictive value (PPV) of 97.6%. Whereas all 52 instable scaphoid non-unions were diagnosed correctly by videofluoroscopy (PPV 100%), one of the 22 partially stable scaphoid non-unions was considered instable in fluoroscopy (PPV 95.5%).

Dynamic videofluoroscopic assessment of the wrist is a reliable tool in differentiating stable from partially or completely instable scaphoid non-union.

The differentiation of completely and partially stable scaphoid non-union is important as both cannot reliably be distinguished by MR imaging.

Holzapfel, K, Werber, K, Rummeny, E, Hannig, C, Dynamic Videofluoroscopic Assessment of Scaphoid Non-union in Decision Finding for Surgical Therapy.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5005563.html