Secrets in scaphoid fractures

Scaphoid fractures are among the most common wrist fractures of patients in the emergency room.
Chapter 1 shows that over the last few decades several classification systems and imaging technologies have been proposed for scaphoid fractures. Reliable prediction model of fracture union cannot be provided.
In Chapter 2 scaphoid fractures were imaged using 3D imaging techniques. A new simplified classification was proposed; 1) proximal pole fractures, (2) a range of waist fractures, and (3) distal tubercle fractures.
In Chapter 3 the simplified scaphoid fracture classification was taken in use in a database study and inter-observer study. It shows to be easily reproducible.
In Chapter 4 radiographs and CT-scans are used to diagnose proximal pole fractures using an interobserver study. This study suggests that CT-scans do not meaningfully improve the reliability of diagnosis of fracture location or displacement.
In Chapter 5 we tested the agreement between observers on the extent of union of a scaphoid waist fracture on CT. We concluded there is limited reliability of diagnosis of partial union of a scaphoid waist fracture on CT.
In Chapter 6 we studied if physicians can determine if a scaphoid fractures are acute or nonunited using radiographs and CT-scans. We found that distinction of nonunions from acute fractures of the scaphoid is reliable without a CT.
In Chapter 7 new imaging modality, the I-Space, a virtual reality system, was used diagnosing occult scaphoid fractures. Results of this study suggest that the I-space is a modality with a fast learning curve and a potential clinical usefulness.