Gadolinium-enhanced preoperative MRI scans as a prognostic parameter in scaphoid nonunion.
The purpose of this prospective study was to correlate preoperative gadolinium-enhanced MRI scans with intraoperative bleeding of the proximal fragment and postoperative union in a series of consecutive patients with established scaphoid nonunions. In 60 patients (6 females, 54 males) with a mean age of 29 years, scaphoid perfusion was judged preoperatively as normal, impaired or absent using a gadolinium-enhanced MRI scan. Scaphoid reconstruction was performed using a nonvascularized bone graft and screw fixation. Perfusion of the proximal fragment was assessed intraoperatively in 49 of 60 patients; compromised or absent vascularity was predicted with a specificity of 90% by contrast-enhanced MRI. However, there was no significant correlation between preoperative MRI assessment of vascularity and subsequent union of the scaphoid.
Megerle
K
K
Clinic for Hand Surgery, Salzburger Leite 1, Institute for Diagnostic and Interventional Radiology Bad Neustadt/Saale and Handcenter Ravensburg Germany, Ravensburg, Germany. megerle@uni-heidelberg.de
Worg
H
H
Christopoulos
G
G
Schmitt
R
R
Krimmer
H
H
D000293:Adolescent; D000328:Adult; D001863:Bone Screws; D016025:Bone Transplantation; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D005593:Fracture Fixation, Internal; D017102:Fracture Healing / Q000502:physiology; D005599:Fractures, Ununited / Q000175:diagnosis* / Q000601:surgery*; D005682:Gadolinium; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology; D021361:Scaphoid Bone / Q000098:blood supply / Q000293:injuries*; D012680:Sensitivity and Specificity; D055815:Young Adult
D003287:Contrast Media; D005682:Gadolinium