Scaphoid blood flow and acute fracture healing.  A dynamic MRI study with enhancement with gadolinium.
We have investigated whether assessment of blood flow to the proximal scaphoid can be used to predict nonunion in acute fractures of the scaphoid. We studied 32 fractures of the scaphoid one to two weeks after injury, by dynamic fat-suppressed T1-weighted gradient-echo MRI after the intravenous administration of gadopentetate dimeglumine (0.1 mmol/kg body-weight). Steepest slope values (SSV) and percentage enhancement values (%E) were calculated for the distal and proximal fragments and poles. All the fractures were treated by immobilisation in a cast, and union was assessed by CT at 12 weeks. Nonunion occurred in four fractures (12%), and there was no statistically significant difference between the proximal fragment SSV and %E values for the fractures which united and those with nonunion. The difference between the proximal pole SSV and %E values for the union and nonunion groups reached statistical significance (p < 0.05), but with higher enhancement parameters for the nonunion group. Our results suggest that poor proximal vascularity is not an important determinant of union in fractures of the scaphoid.
Dawson
J S
JS
Department of Diagnostic Imaging, University Hospital, Nottingham, England, UK.
Martel
A L
AL
Davis
T R
TR
D000293:Adolescent; D000328:Adult; D000368:Aged; D003287:Contrast Media; D005260:Female; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000503:physiopathology*; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow; D021361:Scaphoid Bone / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000293:injuries*; D014057:Tomography, X-Ray Computed
D003287:Contrast Media; D019786:Gadolinium DTPA