- Email: [email protected]
Journal CME Questions
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12. 13.
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fractures be fixed? A randomized controlled trial. J Bone Joint Surg Am. 2005;87(10):2160 –2168. McQueen MM, Gelbke MK, Wakefield A, Will EM, Gaebler C. Percutaneous screw fixation versus conservative treatment for fractures of the waist of the scaphoid: a prospective randomised study. J Bone Joint Surg Br. 2008;90(1):66 –71. Vinnars B, Pietreanu M, Bodestedt A, Ekenstam F, Gerdin B. Nonoperative compared with operative treatment of acute scaphoid fractures. A randomized clinical trial. J Bone Joint Surg Am. 2008;90(6):1176–1185. Arora R, Gschwentner M, Krappinger D, et al. Fixation of nondisplaced scaphoid fractures: making treatment cost effective. Prospective controlled trial. Arch Orthop Trauma Surg. 2007;127(1):39–46. Bain GI, Bennett JD, MacDermid JC, et al. Measurement of the scaphoid humpback deformity using longitudinal computed tomography: intra- and interobserver variability using various measurement techniques. J Hand Surg Am. 1998;23(1):76 – 81. Ring D, Patterson JD, Levitz S, Wang C, Jupiter JB. Both scanning plane and observer affect measurements of scaphoid deformity. J Hand Surg Am. 2005;30(4):696 –701. Amadio PC, Berquist TH, Smith DK, et al. Scaphoid malunion. J Hand Surg Am. 1989;14(4):679 – 687. Bernard SA, Murray PM, Heckman MG. Validity of conventional radiography in determining scaphoid waist fracture displacement. J Orthop Trauma. 2010;24(7):448 – 451. Temple CL, Ross DC, Bennett JD, et al. Comparison of sagittal computed tomography and plain film radiography in a scaphoid fracture model. J Hand Surg Am. 2005;30(3):534 –542. Lozano-Calderon S, Blazar P, Zurakowski D, Lee SG, Ring D. Diagnosis of scaphoid fracture displacement with radiography and computed tomography. J Bone Joint Surg Am. 2006;88(12):2695–2703. Buijze GA, Guitton TG, van Dijk CN, Ring D. Training improves interobserver reliability for the diagnosis of scaphoid fracture displacement. Clin Orthop Relat Res. 2012;470(7):2029 –2034. Buijze GA, Jorgsholm P, Thomsen NO, et al. Factors associated with arthroscopically determined scaphoid fracture displacement and instability. J Hand Surg Am. 2012;37(7):1405–1410. Gellman H, Caputo RJ, Carter V, Aboulafia A, McKay M. Comparison of short and long thumb-spica casts for non-displaced fractures of the carpal scaphoid. J Bone Joint Surg Am. 1989;71(3):354 –357.
787
19. Alho A, Kankaanpaa. Management of fractured scaphoid bone. A prospective study of 100 fractures. Acta Orthop Scand. 1975;46(5):737–743. 20. Clay NR, Dias JJ, Costigan PS, Gregg PJ, Barton NJ. Need the thumb be immobilised in scaphoid fractures? A randomised prospective trial. J Bone Joint Surg Br. 1991;73(5):828 – 832. 21. Hambidge JE, Desai VV, Schranz PJ, et al. Acute fractures of the scaphoid. Treatment by cast immobilisation with the wrist in flexion or extension? J Bone Joint Surg Br. 1999;81(1):91–92. 22. Amirfeyz R, Bebbington A, Downing ND, Oni JA, Davis TR. Displaced scaphoid waist fractures: the use of a week 4 CT scan to predict the likelihood of union with nonoperative treatment. J Hand Surg Eur. 2011;36(6):498 –502. 23. Herbert TJ, Fisher WE. Management of the fractured scaphoid using a new bone screw. J Bone Joint Surg Br. 1984;66(1):114 –123. 24. Eddeland A, Eiken O, Hellgren E, Ohlsson NM. Fractures of the scaphoid. Scand J Plast Reconstr Surg. 1975;9(3):234 –239. 25. Cooney WP, Dobyns JH, Linscheid RL. Fractures of the scaphoid: a rational approach to management. Clin Orthop Relat Res. 1980;149:90–97. 26. Thorleifsson R, Karlsson J, Sigurjonsson K. Fractures of the scaphoid bone. A follow-up study. Arch Orthop Trauma Surg. 1984;103(2):96–99. 27. Megerle K, Harenberg PS, Germann G, Hellmich S. Scaphoid morphology and clinical outcomes in scaphoid reconstructions. Injury. 2012;43(3):306 –310. 28. Desai VV, Davis TR, Barton NJ. The prognostic value and reproducibility of the radiological features of the fractured scaphoid. J Hand Surg Br. 1999;24(5):586 –590. 29. Compson JP. The anatomy of acute scaphoid fractures: a three-dimensional analysis of patterns. J Bone Joint Surg Br. 1998;80(2):218 –224. 30. Russe O. Fracture of the carpal navicular. Diagnosis, non-operative treatment, and operative treatment. J Bone Joint Surg Am. July 1960;42-A:759 –768. 31. Bhat M, McCarthy M, Davis TR, Oni JA, Dawson S. MRI and plain radiography in the assessment of displaced fractures of the waist of the carpal scaphoid. J Bone Joint Surg Br. 2004;86(5):705–713. 32. Buijze GA, Jørgsholm P, Thomsen NOB, et al. Diagnostic performance of radiographs and computed tomography for displacement and instability of acute scaphoid waist fractures. J Bone Joint Surg Am. 2007;94(21):1967–1974.
JOURNAL CME QUESTIONS Diagnosis of Scaphoid Fracture Displacement Which of the following statements describes best the diagnosis or prognosis of scaphoid fractures? a. CT as opposed to radiographs improves sensitivity but not specificity of scaphoid fractures. b. CT as opposed to radiographs improves specificity but not sensitivity of scaphoid fractures. c. Radiographic displacement and classification correlate with union rate. d. Fractures displaced less than 2 mm on CT are less likely to unite. e. CT scan can predict the likelihood of scaphoid fracture union.
A 0.5-mm scaphoid fracture gap: a. Can be accurately assessed with radiographs. b. Cannot be diagnosed by CT scan. c. Should be considered a nondisplaced fracture. d. Can be more accurately assessed by CT than radiographs. e. Should only be diagnosed by arthroscopy because it is the reference standard.
To take the online test and receive CME credit, go to http://www.jhandsurg.org/CME/home.
JHS 䉬 Vol A, April
Evidence-Based Medicine
DIAGNOSIS OF SCAPHOID FRACTURE DISPLACEMENT
8.
9.
10.
11.
12. 13.
14.
15.
16.
17.
18.
fractures be fixed? A randomized controlled trial. J Bone Joint Surg Am. 2005;87(10):2160 –2168. McQueen MM, Gelbke MK, Wakefield A, Will EM, Gaebler C. Percutaneous screw fixation versus conservative treatment for fractures of the waist of the scaphoid: a prospective randomised study. J Bone Joint Surg Br. 2008;90(1):66 –71. Vinnars B, Pietreanu M, Bodestedt A, Ekenstam F, Gerdin B. Nonoperative compared with operative treatment of acute scaphoid fractures. A randomized clinical trial. J Bone Joint Surg Am. 2008;90(6):1176–1185. Arora R, Gschwentner M, Krappinger D, et al. Fixation of nondisplaced scaphoid fractures: making treatment cost effective. Prospective controlled trial. Arch Orthop Trauma Surg. 2007;127(1):39–46. Bain GI, Bennett JD, MacDermid JC, et al. Measurement of the scaphoid humpback deformity using longitudinal computed tomography: intra- and interobserver variability using various measurement techniques. J Hand Surg Am. 1998;23(1):76 – 81. Ring D, Patterson JD, Levitz S, Wang C, Jupiter JB. Both scanning plane and observer affect measurements of scaphoid deformity. J Hand Surg Am. 2005;30(4):696 –701. Amadio PC, Berquist TH, Smith DK, et al. Scaphoid malunion. J Hand Surg Am. 1989;14(4):679 – 687. Bernard SA, Murray PM, Heckman MG. Validity of conventional radiography in determining scaphoid waist fracture displacement. J Orthop Trauma. 2010;24(7):448 – 451. Temple CL, Ross DC, Bennett JD, et al. Comparison of sagittal computed tomography and plain film radiography in a scaphoid fracture model. J Hand Surg Am. 2005;30(3):534 –542. Lozano-Calderon S, Blazar P, Zurakowski D, Lee SG, Ring D. Diagnosis of scaphoid fracture displacement with radiography and computed tomography. J Bone Joint Surg Am. 2006;88(12):2695–2703. Buijze GA, Guitton TG, van Dijk CN, Ring D. Training improves interobserver reliability for the diagnosis of scaphoid fracture displacement. Clin Orthop Relat Res. 2012;470(7):2029 –2034. Buijze GA, Jorgsholm P, Thomsen NO, et al. Factors associated with arthroscopically determined scaphoid fracture displacement and instability. J Hand Surg Am. 2012;37(7):1405–1410. Gellman H, Caputo RJ, Carter V, Aboulafia A, McKay M. Comparison of short and long thumb-spica casts for non-displaced fractures of the carpal scaphoid. J Bone Joint Surg Am. 1989;71(3):354 –357.
787
19. Alho A, Kankaanpaa. Management of fractured scaphoid bone. A prospective study of 100 fractures. Acta Orthop Scand. 1975;46(5):737–743. 20. Clay NR, Dias JJ, Costigan PS, Gregg PJ, Barton NJ. Need the thumb be immobilised in scaphoid fractures? A randomised prospective trial. J Bone Joint Surg Br. 1991;73(5):828 – 832. 21. Hambidge JE, Desai VV, Schranz PJ, et al. Acute fractures of the scaphoid. Treatment by cast immobilisation with the wrist in flexion or extension? J Bone Joint Surg Br. 1999;81(1):91–92. 22. Amirfeyz R, Bebbington A, Downing ND, Oni JA, Davis TR. Displaced scaphoid waist fractures: the use of a week 4 CT scan to predict the likelihood of union with nonoperative treatment. J Hand Surg Eur. 2011;36(6):498 –502. 23. Herbert TJ, Fisher WE. Management of the fractured scaphoid using a new bone screw. J Bone Joint Surg Br. 1984;66(1):114 –123. 24. Eddeland A, Eiken O, Hellgren E, Ohlsson NM. Fractures of the scaphoid. Scand J Plast Reconstr Surg. 1975;9(3):234 –239. 25. Cooney WP, Dobyns JH, Linscheid RL. Fractures of the scaphoid: a rational approach to management. Clin Orthop Relat Res. 1980;149:90–97. 26. Thorleifsson R, Karlsson J, Sigurjonsson K. Fractures of the scaphoid bone. A follow-up study. Arch Orthop Trauma Surg. 1984;103(2):96–99. 27. Megerle K, Harenberg PS, Germann G, Hellmich S. Scaphoid morphology and clinical outcomes in scaphoid reconstructions. Injury. 2012;43(3):306 –310. 28. Desai VV, Davis TR, Barton NJ. The prognostic value and reproducibility of the radiological features of the fractured scaphoid. J Hand Surg Br. 1999;24(5):586 –590. 29. Compson JP. The anatomy of acute scaphoid fractures: a three-dimensional analysis of patterns. J Bone Joint Surg Br. 1998;80(2):218 –224. 30. Russe O. Fracture of the carpal navicular. Diagnosis, non-operative treatment, and operative treatment. J Bone Joint Surg Am. July 1960;42-A:759 –768. 31. Bhat M, McCarthy M, Davis TR, Oni JA, Dawson S. MRI and plain radiography in the assessment of displaced fractures of the waist of the carpal scaphoid. J Bone Joint Surg Br. 2004;86(5):705–713. 32. Buijze GA, Jørgsholm P, Thomsen NOB, et al. Diagnostic performance of radiographs and computed tomography for displacement and instability of acute scaphoid waist fractures. J Bone Joint Surg Am. 2007;94(21):1967–1974.
JOURNAL CME QUESTIONS Diagnosis of Scaphoid Fracture Displacement Which of the following statements describes best the diagnosis or prognosis of scaphoid fractures? a. CT as opposed to radiographs improves sensitivity but not specificity of scaphoid fractures. b. CT as opposed to radiographs improves specificity but not sensitivity of scaphoid fractures. c. Radiographic displacement and classification correlate with union rate. d. Fractures displaced less than 2 mm on CT are less likely to unite. e. CT scan can predict the likelihood of scaphoid fracture union.
A 0.5-mm scaphoid fracture gap: a. Can be accurately assessed with radiographs. b. Cannot be diagnosed by CT scan. c. Should be considered a nondisplaced fracture. d. Can be more accurately assessed by CT than radiographs. e. Should only be diagnosed by arthroscopy because it is the reference standard.
To take the online test and receive CME credit, go to http://www.jhandsurg.org/CME/home.
JHS 䉬 Vol A, April
Evidence-Based Medicine
DIAGNOSIS OF SCAPHOID FRACTURE DISPLACEMENT