Acute and subacute scaphoid fractures were assessed using 3D computer tomography (CT). The aims were to describe fracture morphology, to map fractures onto a 3D scaphoid model and to correlate this to scaphoid anatomy.
Materials and methods
A retrospective, multicentre database search was performed to identify CT studies of acute and subacute scaphoid fractures. CT scans of scaphoid fractures less than 6 weeks from time of injury were included in this retrospective, multicentre study. CTs were segmented and converted into three-dimensional models. Following virtual fracture reduction, fractures were mapped onto a three-dimensional scaphoid model.
Seventy-five CT scans were included. The median delay from injury to CT was 29 days. Most studies were in male patients (89%). Most fractures were comminuted (52%) or displaced (64%). A total of 73% of displaced fractures had concomitant comminution. Waist fractures had higher rates of comminution and displacement when compared with all other fractures. Comminution was located along the dorsal ridge and the volar scaphoid waist.
Our study is the first to describe acute fracture morphology using 3D CT and to correlate comminution and displacement to fracture types. The dorsal ridge and volar waist need prudent assessment, especially in waist fractures.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Destot E. The classic: injuries of the wrist: a radiological study. New York, NY: Paul B. Hoeber; 1926. Clin Orthop Relat Res. 2006;445:8–14.
Ten Berg PW, Drijkoningen T, Strackee SD, Buijze GA. Classifications of acute scaphoid fractures: a systematic literature review. J Wrist Surg. 2016;5(2):152–9.
Herbert TJ, Fisher WE. Management of the fractured scaphoid using a new bone screw. J Bone Joint Surg Br. 1984;66(1):114–23.
Cooney WP, Dobyns JH, Linscheid RL. Fractures of the scaphoid: a rational approach to management. Clin Orthop Relat Res. 1980;149:90–7.
Russe O. Fracture of the carpal navicular: diagnosis, non-operative treatment, and operative treatment. J Bone Joint Surg Am. 1960;42-A(5):759–68.
Ceri N, Korman E, Gunal I, Tetik S. The morphological and morphometric features of the scaphoid. J Hand Surg Br. 2004;29(4):393–8.
Craigen M, Stanley J. Wrist kinematics: row, column or both? J Hand Surg Am. 1995;20(2):165–70.
Garcia-Elias M, Ribe M, Rodriguez J, Cots M, Casas J. Influence of joint laxity on scaphoid kinematics. J Hand Surg Br. 1995;20(3):379–82.
Shenoy R, Pillai A, Hadidi M. Scaphoid fractures: variation in radiographic views - a survey of current practice in the West of Scotland region. Eur J Emerg Med. 2007;14(1):2–5.
Tiel-van Buul MM, van Beek EJ, Broekhuizen AH, Nooitgedacht EA, Davids PH, Bakker AJ. Diagnosing scaphoid fractures: radiographs cannot be used as a gold standard! Injury. 1992;23(2):77–9.
Hunter JC, Escobedo EM, Wilson AJ, Hanel DP, Zink-Brody GC, Mann FA. MR imaging of clinically suspected scaphoid fractures. AJR Am J Roentgenol. 1997;168(5):1287–93.
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 Vol. 2011;36(6):498–502.
Eastley N, Singh H, Dias JJ, Taub N. Union rates after proximal scaphoid fractures; meta-analyses and review of available evidence. J Hand Surg Eur Vol. 2013;38(8):888–97.
Grewal R, Suh N, Macdermid JC. Use of computed tomography to predict union and time to union in acute scaphoid fractures treated nonoperatively. J Hand Surg Am. 2013;38(5):872–7.
Luria S, Schwarcz Y, Wollstein R, Emelife P, Zinger G, Peleg E. 3-dimensional analysis of scaphoid fracture angle morphology. J Hand Surg Am. 2015;40(3):508–14.
Green DP, Wolfe SW. Green's operative hand surgery. 6th ed. Philadelphia: Saunders/Elsevier; 2011.
Slutsky DJ, Slade JF. Scaphoid. New York: Thieme; 2011.
Compson JP. The anatomy of acute scaphoid fractures: a three-dimensional analysis of patterns. J Bone Joint Surg Br. 1998;80(2):218–24.
Clementson M, Jorgsholm P, Besjakov J, Bjorkman A, Thomsen N. Union of scaphoid waist fractures assessed by CT scan. J Wrist Surg. 2015;4(1):49–55.
Buijze GA, Jorgsholm P, Thomsen NO, Bjorkman A, Besjakov J, Ring D. Factors associated with arthroscopically determined scaphoid fracture displacement and instability. J Hand Surg Am. 2012;37(7):1405–10.
Grewal R, Lutz K, MacDermid JC, Suh N. Proximal pole scaphoid fractures: a computed tomographic assessment of outcomes. J Hand Surg Am. 2016;41(1):54–8.
Hu YL, Ye FG, Ji AY, Qiao GX, Liu HF. Three-dimensional computed tomography imaging increases the reliability of classification systems for tibial plateau fractures. Injury. 2009;40(12):1282–5.
Pialat JB, Burghardt AJ, Sode M, Link TM, Majumdar S. Visual grading of motion induced image degradation in high resolution peripheral computed tomography: impact of image quality on measures of bone density and micro-architecture. Bone. 2012;50(1):111–8.
Cooney WP, Linscheid RL, Dobyns JH, Wood MB. Scaphoid nonunion: role of anterior interpositional bone grafts. J Hand Surg Am. 1988;13(5):635–50.
Temple CL, Ross DC, Bennett JD, Garvin GJ, King GJ, Faber KJ. Comparison of sagittal computed tomography and plain film radiography in a scaphoid fracture model. J Hand Surg Am. 2005;30(3):534–42.
Sanders WE. Evaluation of the humpback scaphoid by computed tomography in the longitudinal axial plane of the scaphoid. J Hand Surg Am. 1988;13(2):182–7.
Schwarcz Y, Schwarcz Y, Peleg E, Joskowicz L, Wollstein R, Luria S. Three-dimensional analysis of acute scaphoid fracture displacement: proximal extension deformity of the scaphoid. J Bone Joint Surg Am. 2017;99(2):141–9.
Fogg QA. Scaphoid variation and an anatomical basis for variable carpal mechanics [Ph.D thesis]. Adelaide: The University of Adelaide; 2004.
Kijima Y, Viegas SF. Wrist anatomy and biomechanics. J Hand Surg Am. 2009;34(8):1555–63.
Moritomo H, Murase T, Oka K, Tanaka H, Yoshikawa H, Sugamoto K. Relationship between the fracture location and the kinematic pattern in scaphoid nonunion. J Hand Surg Am. 2008;33(9):1459–68.
Prosser AJ, Brenkel IJ, Irvine GB. Articular fractures of the distal scaphoid. J Hand Surg Br. 1988;13(1):87–91.
Garala K, Dias J. Scaphoid fracture geometrics: an assessment of location and orientation. J Plast Surg Hand Surg. 2019;53(3):180–7.
Trumble TE, Vo D. Proximal pole scaphoid fractures and nonunion. J Am Soc Surg Hand. 2001;1(3):155–71.
Su-Bum AL, Hyo-Jin BK, Jae-Myeung CC, Choon-Sung DL, Shin-Yoon EK, Poong-Taek FK, et al. Osseous microarchitecture of the scaphoid: cadaveric study of regional variations and clinical implications. Clin Anat. 2012;25(2):203–11.
Weber ER, Chao EY. An experimental approach to the mechanism of scaphoid waist fractures. J Hand Surg Am. 1978;3(2):142–8.
Green JR Jr, Rayan GM. Scaphoid fractures in soccer goalkeepers. J Okla State Med Assoc. 1997;90(2):45–7.
Horii E, Nakamura R, Watanabe K, Tsunoda K. Scaphoid fracture as a" puncher's fracture". J Orthop Trauma. 1994;8(2):107–10.
Apergis E. Fracture-dislocations of the wrist. Milan: Springer; 2013.
Oka K, Murase T, Moritomo H, Goto A, Sugamoto K, Yoshikawa H. Patterns of bone defect in scaphoid nonunion: a 3-dimensional and quantitative analysis. J Hand Surg Am. 2005;30(2):359–65.
Leslie IJ, Dickson RA. The fractured carpal scaphoid. Natural history and factors influencing outcome. J Bone Joint Surg Br. 1981;63-B(2):225–30.
Conflicts of interest and source of funding
A.E.B. has received funding from KNAW van Leersum Foundation and the Marti-Keuning-Eckhardt Foundation in support of their research for or preparation of this work.
Ethics approval was granted from the Southern Adelaide Clinical Human Research Ethics Committee.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Arthur Turow and Anne Eva Bulstra are co-first authors.
Electronic supplementary material
About this article
Cite this article
Turow, A., Bulstra, A.E., Oldhoff, M. et al. 3D mapping of scaphoid fractures and comminution. Skeletal Radiol 49, 1633–1647 (2020). https://doi.org/10.1007/s00256-020-03457-1
- Acute fractures
- Computer tomography
- 3D CT