Determining diagnosis of scaphoid healing: Comparison of cone beam CT and X-ray after six weeks of immobilization

Lucia Calisto Farracho, Berenice Moutinot, Angeliki Neroladaki, Marion Hamard, Karel Gorican, Pierre Alexandre Poletti, Jean Yves Beaulieu, Cindy Bouvet, Sana Boudabbous, Lucia Calisto Farracho, Berenice Moutinot, Angeliki Neroladaki, Marion Hamard, Karel Gorican, Pierre Alexandre Poletti, Jean Yves Beaulieu, Cindy Bouvet, Sana Boudabbous

Abstract

Purpose: To assess the accuracy and reliability of using cone beam computed tomography (CBCT) compared to X-ray six weeks after injury for predicting scaphoid union.

Materials and methods: Overall; 52 patients with scaphoid fractures between April 2018 and March 2019 were prospectively included in this study. The mean age was 34.52 (13-88) years, and the gender ratio male/female 43/9. Of the fractures, 26 had occurred on the right side, and 26 on the left side. In total, 28 % of patients were manual workers. All patients underwent X-ray and CBCT six weeks after injury. Four readers, two radiologists, and two hand surgeons analyzed the findings using double-blinded X-ray and CBCT and categorized fractures as consolidated based on a 50 % visibility threshold concerning trabecular bridges. Proximal pole sclerosis, communition, cyst formation, and humpback deformity were similarly analyzed for all cases. Agreement between readers was calculated using Kappa, and sensitivity, specificity, and accuracy using RStudio software. The gold standard was the radiologic and clinical follow-up for all patients at two months.

Results: Inter-reader agreement between the four readers was moderate concerning X-ray (0.543) but substantial concerning CBCT (0.641). It was almost perfect between seniors regarding CBCT (Kappa = 0.862). Sensitivity, specificity, and accuracy were 0.75-0.78, 0.4, and 0.61-0.64, respectively, for two readers regarding CBCT. The X-ray values were 0.65-0.71, 0.35-0.4, and 0.53-0.59, respectively.

Conclusion: CBCT proves more accurate and reliable than X-ray for diagnosing scaphoid union at an early follow-up and prevents longer immobilization and interruption of activity or work.

Keywords: CBCT; Immobilisation; Scaphoid healing; X-rays.

© 2020 The Authors.

Figures

Fig. 1
Fig. 1
Manual worker aged 34 years with an unstable fracture in Schoenberg’s zone III of the right scaphoid according to Mayo criteria [21] treated with surgery to stabilize the fracture. XR (a) showed no healing, according to all readers. To the contrary, CBCT (b) showed total agreement of scaphoid consolidation.
Fig. 2
Fig. 2
CBCT (a) of a 36-year-old, office worker with a right scaphoid fracture in Schoenberg’s zone III with complete healing according to all readers. XR (b) of the same patient shows no evidence of scaphoid healing.

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