Gadolinium-enhanced preoperative MRI scans as a prognostic parameter in scaphoid nonunion

• Published in: The Journal of hand surgery, European volume Vol. 36; no. 1; p. 23
• Main Authors: Megerle, K, Worg, H, Christopoulos, G, Schmitt, R, Krimmer, H
• Format: Journal Article
• Language: English
• Published: England 01.01.2011
• Subjects: Adolescent; Adult; Bone Screws; Bone Transplantation; Contrast Media - administration & dosage; Female; Fracture Fixation, Internal; Fracture Healing - physiology; Fractures, Ununited - diagnosis; Fractures, Ununited - surgery; Gadolinium; Humans; Image Enhancement - methods; Image Processing, Computer-Assisted - methods; Magnetic Resonance Imaging - methods; Male; Middle Aged; Preoperative Care; Prospective Studies; Regional Blood Flow - physiology; Scaphoid Bone - blood supply; Scaphoid Bone - injuries; Sensitivity and Specificity; Young Adult
• ISSN: 2043-6289
• DOI: 10.1177/1753193410375776

The purpose of this prospective study was to correlate preoperative gadolinium-enhanced MRI scans with intraoperative bleeding of the proximal fragment and postoperative union in a series of consecutive patients with established scaphoid nonunions. In 60 patients (6 females, 54 males) with a mean age of 29 years, scaphoid perfusion was judged preoperatively as normal, impaired or absent using a gadolinium-enhanced MRI scan. Scaphoid reconstruction was performed using a nonvascularized bone graft and screw fixation. Perfusion of the proximal fragment was assessed intraoperatively in 49 of 60 patients; compromised or absent vascularity was predicted with a specificity of 90% by contrast-enhanced MRI. However, there was no significant correlation between preoperative MRI assessment of vascularity and subsequent union of the scaphoid.