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Gadolinium Enhanced Mr Assessment of Proximal Fragment Vascularity in Nonunions after Scaphoid Fracture: Does It Predict the Outcome of Reconstructive Surgery?From the Departments of Trauma and Orthopaedic Surgery and Diagnostic Imaging, Queen’s Medical Centre, University Hospital, Nottingham, UK Correspondence: Prof. T.R.C. Davis, Department of Trauma and Orthopaedic Surgery, Queen’s Medical Centre, University Hospital, Nottingham, NG7 2UH, UK. Tel.: +44-1159249924x44337; fax: +44-1159209921; E-mail: tim.davis3{at}ntlworld.com. This study investigated whether the outcome of bone graft and internal fixation surgery for nonunion of scaphoid fractures could be predicted by gadolinium-enhanced MR assessments of proximal fragment vascularity. Sixteen established scaphoid fracture nonunions underwent gadolinium-enhanced MR scanning before surgical treatment with bone grafting and internal fixation. No relationship was found between MR enhancement and the outcome of surgery. Union was achieved in eight of the 12 nonunions with more than 50% enhancement, and three of the four with less than 50% enhancement, of the proximal pole. Furthermore, union was achieved in both of the nonunions which had less than 25% enhancement of the proximal pole. We conclude that enhanced MR assessments of the vascularity of the proximal fragment of a scaphoid fracture nonunion do not accurately predict the outcome of reconstructive surgery.
Key Words: scaphoid • nonunion • vascularity • gadolinium • surgery
Journal of Hand Surgery (British and European Volume), Vol. 29, No. 5,
444-448 (2004) |
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