Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 1/2023

Open Access 27-09-2022 | Scaphoid Fracture | Original Article

Morphological risk factors for scaphoid fracture: a case–control study

Authors: Abigael Cohen, Thomas Claessen, Corne van den Berg, Michiel Siebelt, Tjebbe Hagenaars, Gerald A. Kraan, Johannes H. Waarsing, Max Reijman, Joost W. Colaris

Published in: European Journal of Trauma and Emergency Surgery | Issue 1/2023

Login to get access

Abstract

Purpose

Most patients with a clinically suspected scaphoid fracture and normal initial radiograph are unnecessarily treated. Previously developed prediction rules using demographic and clinical risk are unable to accurately predict occult fractures. Adding other risk factors could enhance this. Therefore, we aim to explore if there are morphological risk factors of the wrist for sustaining a scaphoid fracture.

Methods

We retrospectively included adult patients with a clinically suspected scaphoid fracture between 2013 and 2019 in our case–control study. There were 82 patients with a scaphoid fracture and 158 patients with a wrist contusion. Morphological risk factors were identified using statistical shape modelling (SSM) and linear measurements. Independent wrist shape variations on posteroanterior and lateral radiographs were captured in modes using SSM. Associations between outcomes and a scaphoid fracture were explored using logistic regression and the reliability was assessed.

Results

Of the 15 posteroanterior modes and 8 lateral modes identified and linear measurements performed, 1 PA mode was associated with a scaphoid fracture (PA mode 4; OR 1.40, CI 1.04–1.93, p = 0.031). We described this mode as an ulna plus and narrower distal radius with more volar tilt and radial inclination. The reliability of the posteroanterior modes and linear measurements was mostly good/excellent and moderate/poor for the lateral modes.

Conclusion

There was one complex wrist shape significantly associated with a scaphoid fracture. Since the association was weak and the shape is difficult to identify radiographs, we believe this morphological risk factor would not enhance identifying occult scaphoid fractures in the future.
Appendix
Available only for authorised users
Literature
1.
Agricola R, Leyland KM, Bierma-Zeinstra SM, Thomas GE, Emans PJ, Spector TD, Weinans H, Waarsing JH, Arden NK. Validation of statistical shape modelling to predict hip osteoarthritis in females: data from two prospective cohort studies (Cohort Hip and Cohort Knee and Chingford). Rheumatology (Oxford). 2015;54:2033–41.CrossRefPubMed
2.
Akhbari B, Shah KN, Morton AM, Moore DC, Weiss AC, Wolfe SW, Crisco JJ. Biomechanics of the distal radioulnar joint during in vivo forearm pronosupination. J Wrist Surg. 2021;10:208–15.CrossRefPubMedPubMedCentral
3.
Baker-LePain JC, Luker KR, Lynch JA, Parimi N, Nevitt MC, Lane NE. Active shape modeling of the hip in the prediction of incident hip fracture. J Bone Miner Res. 2011;26:468–74.CrossRefPubMed
4.
Choi WJ, Robinovitch SN. Pressure distribution over the palm region during forward falls on the outstretched hands. J Biomech. 2011;44:532–9.CrossRefPubMed
5.
de Zwart AD, Beeres FJ, Rhemrev SJ, Bartlema K, Schipper IB. Comparison of MRI, CT and bone scintigraphy for suspected scaphoid fractures. Eur J Trauma Emerg Surg. 2016;42:725–31.CrossRefPubMed
6.
Duckworth AD, Buijze GA, Moran M, Gray A, Court-Brown CM, Ring D, McQueen MM. Predictors of fracture following suspected injury to the scaphoid. J Bone Jt Surg Br. 2012;94:961–8.CrossRef
7.
8.
Gill D, Lyer S, Alexiou C, Fried F, Buder T, Neuhuber W, Jacxsens M, Horch RE, Arkudas A. Anatomical study of all carpal and adjoining bones of the wrist using 3D CT reconstruction—finding the ultimate biomechanical theory. Ann Anat Anatomischer Anzeiger. 2022;242: 151909.CrossRefPubMed
9.
Harley BJ, Pereria ML, Werner FW, Kinney DA, Sutton LG. Force variations in the distal radius and ulna: effect of ulnar variance and forearm motion. J Hand Surg. 2015;40:211–6.CrossRef
10.
Inoue G, Sakuma M. The natural history of scaphoid non-union .Radiographical and clinical analysis in 102 cases. Arch Orthop Trauma Surg. 1996;115:1–4.CrossRefPubMed
11.
Kiebzak G, Sassard WR. Smaller radius width in women with distal radius fractures compared to women without fractures. Cureus. 2017;9: e1950.PubMedPubMedCentral
12.
Lindner C, Thiagarajah S, Wilkinson JM, Wallis GA, Cootes TF, The arc OC. Fully automatic segmentation of the proximal femur using random forest regression voting. IEEE Trans Med Imaging. 2013;32:1462–72.CrossRefPubMed
13.
Majima M, Horii E, Matsuki H, Hirata H, Genda E. Load transmission through the wrist in the extended position. J Hand Surg Am. 2008;33:182–8.CrossRefPubMed
14.
Mallee WH, Veltman ES, Doornberg JN, Blankevoort L, van Dijk CN, Goslings JC. [Variations in management of suspected scaphoid fractures] Variatie in beleid bij vermoeden op scafoidfractuur. Ned Tijdschr Geneeskd. 2012;156:A4514.PubMed
15.
Mallee WH, Walenkamp MMJ, Mulders MAM, Goslings JC, Schep NWL. Detecting scaphoid fractures in wrist injury: a clinical decision rule. Arch Orthop Trauma Surg. 2020;140:575–81.CrossRefPubMedPubMedCentral
16.
Padmore CE, Chan AHW, Langohr GDG, Johnson JA, Suh N. The effect of forearm position on wrist joint biomechanics. J Hand Surg Am. 2021;46(425):e421-425e410.
17.
Pfaeffle HJ, Manson T, Fischer KJ, Herndon JH, Woo SLY, Tomaino MM. Axial loading alters ulnar variance and distal ulna load with forearm pronation. Pittsb Orthop J. 1999;10:101–2.
18.
Pillai A, Jain M. Management of clinical fractures of the scaphoid: results of an audit and literature review. Eur J Emerg Med. 2005;12:47–51.CrossRefPubMed
19.
Portney LG, Watkins MP. Foundations of clinical research: applications to practice. Upper Saddle River: Pearson/Prentice Hall; 2009.
20.
Rainbow MJ, Kamal RN, Leventhal E, Akelman E, Moore DC, Wolfe SW, Crisco JJ. In vivo kinematics of the scaphoid, lunate, capitate, and third metacarpal in extreme wrist flexion and extension. J Hand Surg Am. 2013;38:278–88.CrossRefPubMed
21.
Ramos-Escalona J, Garcia-Bordes L, Martinez-Galarza P, Yunta-Gallo A. Ulnar variance and scaphoid fracture. J Hand Surg Eur. 2010;35:195–7.CrossRef
22.
Rhemrev SJ, Beeres FJ, van Leerdam RH, Hogervorst M, Ring D. Clinical prediction rule for suspected scaphoid fractures: a prospective cohort study. Injury. 2010;41:1026–30.CrossRefPubMed
23.
Robinson LS, Sarkies M, Brown T, O’Brien L. Direct, indirect and intangible costs of acute hand and wrist injuries: a systematic review. Injury. 2016;47:2614–26.CrossRefPubMed
24.
25.
Schreibman KL, Freeland A, Gilula LA, Yin Y. Imaging of the hand and wrist. Orthop Clin N Am. 1997;28:537–82.CrossRef
26.
Shaaban H, Giakas G, Bolton M, Williams R, Wicks P, Scheker LR, Lees VC. The load-bearing characteristics of the forearm: pattern of axial and bending force transmitted through ulna and radius. J Hand Surg Br. 2006;31:274–9.CrossRefPubMed
27.
Stirling PHC, Strelzow JA, Doornberg JN, White TO, McQueen MM, Duckworth AD. Diagnosis of suspected scaphoid fractures. JBJS Rev. 2021;9:e20.00247.CrossRef
28.
Turan A, Kose O, Aktan C, Unal M, Acar B, Sindel M. Radiographic analysis of anatomic risk factors for scaphoid fractures; A case-control study. Clin Imaging. 2018;51:341–6.CrossRefPubMed
29.
van Klij P, Heijboer MP, Ginai AZ, Verhaar JAN, Waarsing JH, Agricola R. Cam morphology in young male football players mostly develops before proximal femoral growth plate closure: a prospective study with 5-yearfollow-up. Br J Sports Med. 2019;53:532.CrossRefPubMed
30.
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, Initiative S. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370:1453–7.CrossRef
31.
Weber ER, Chao EY. An experimental approach to the mechanism of scaphoid waist fractures. J Hand Surg Am. 1978;3:142–8.CrossRefPubMed
32.
Werner FW, Palmer AK, Fortino MD, Short WH. Force transmission through the distal ulna: effect of ulnar variance, lunate fossa angulation, and radial and palmar tilt of the distal radius. J Hand Surg. 1992;17:423–8.CrossRef
Metadata
Title
Morphological risk factors for scaphoid fracture: a case–control study
Authors
Abigael Cohen
Thomas Claessen
Corne van den Berg
Michiel Siebelt
Tjebbe Hagenaars
Gerald A. Kraan
Johannes H. Waarsing
Max Reijman
Joost W. Colaris
Publication date
27-09-2022
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 1/2023
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-022-02101-y

Other articles of this Issue 1/2023

European Journal of Trauma and Emergency Surgery 1/2023 Go to the issue

Original Article

Association between three prehospital thoracic decompression techniques by physicians and complications: a retrospective, multicentre study in adults

Original Article

Long-term outcomes after using retrievable vena cava filters in major trauma patients with contraindications to prophylactic anticoagulation

Original Article

Resuscitation with whole blood or blood components improves survival and lessens the pathophysiological burden of trauma and haemorrhagic shock in a pre-clinical porcine model

Original Article

Impact of the implementation of a trauma system on compliance with evidence-based clinical management guidelines in penetrating thoracic trauma

Original Article

The snapshot audit methodology: design, implementation and analysis of prospective observational cohort studies in surgery

Original Article

Pulsatile lavage systems and their potential to penetrate soft tissue