Scaphoid fractures Increasing diagnostic efficiency and treatment functionality

Scaphoid fractures are common injuries that are notorious for their difficult diagnosis and the theoretical risk of nonunion when left undiagnosed or undertreated. The fear of a missed diagnosis or undertreatment, has resulted in defensive diagnostic and treatment protocol leading to overdiagnosis and overtreatment of the (suspected) scaphoid fracture.
In this thesis, the overdiagnosis and overtreatment of acute nondisplaced scaphoid waist fractures was addressed. The overall goal was to reduce unhelpful imaging and immobilization in patients with a suspected or confirmed scaphoid waist fracture. We aimed to increase diagnostic efficiency and treatment functionality in three parts:
In Part I of this thesis – “Diagnosis of the (Suspected) Scaphoid Fracture” - we aimed to improve efficiency and accuracy of acute scaphoid fracture diagnosis, employing innovative techniques such as a Machine Learning clinical decision rule (Chapter 4); Computer Vision fracture detection (Chapter 5) and mapping of MRI signal change (Chapter 6).
In Part II – “Scaphoid Fracture Characteristics” - we aimed to differentiate fractures that heal predictably from those that are at an increased risk of nonunion by investigating fracture characteristics through three-dimensional CT analysis (Chapter 7, 8)
In Part III – “Immobilization Duration of a Nondisplaced Scaphoid Waist Fracture” - we identified potential barriers to adopting shorter immobilization times by investigating factors affecting surgeon decision making through an international survey (Chapter 9) and prospective cohort study (Chapter 10)