Betsch M, Jungbluth P, Hakimi M, Windolf J, Schädel-Höpfner M
Universitätsklinikum Düsseldorf, Unfall- und Handchirurgie, Düsseldorf.
Handchir Mikrochir Plast Chir. 2010 Feb;42(1):71-4. doi: 10.1055/s-0029-1246210. Epub 2010 Mar 4.
Scaphoid fractures represent the most common carpal bone fractures. These fractures may be overlooked due to insufficient diagnostics and lead to non-union and disability. A standardized diagnostic procedure with X-ray examinations, CT scans and/or MRI is recommended. We report on a case where a scaphoid fracture was overlooked, probably because of an incorrect technique of the computed tomography.
A 42-year-old man was admitted to our emergency room after a fall on the out-stretched wrist. X-rays showed no evidence of a bony lesion. In the follow-up examination on the next day, a scaphoid fracture was still suspected clinically. Because of that a CT scan in thin slice technique with axial layers and multiplanar reconstruction was performed but showed no sign of a fracture. Six weeks after the trauma the patient presented with persistent wrist pain. X-rays and a CT scan of the wrist now demonstrated an old waist fracture of the scaphoid. -Operative treatment with iliac crest bone grafting and screw fixation was performed.
Early diagnosis and a correct description of the fracture pattern are of high value in the treatment of scaphoid fractures. X-rays combined with a CT scan or an MRI scan of the affected wrist are considered as the diagnostic standard. The reported case demonstrates that even with a thin thickness layer CT scan in axial planes, a scaphoid fracture can be overlooked. Therefore we recommend after primarily inconspicuous X-rays a CT scan with primary -oblique-sagittal layers in the longitudinal axis of the scaphoid. If this shows no fracture and the clinical suspicion persists, an MRI scan should be performed.
舟骨骨折是最常见的腕骨骨折。由于诊断不足，这些骨折可能被忽视，进而导致骨不连和残疾。建议采用X线检查、CT扫描和/或MRI进行标准化诊断程序。我们报告一例舟骨骨折被漏诊的病例，可能是由于计算机断层扫描技术不正确所致。
一名42岁男性在伸展的手腕受伤后被送入我们的急诊室。X线检查未显示骨损伤迹象。在第二天的随访检查中，临床仍怀疑有舟骨骨折。因此，采用轴向层厚的薄层CT扫描和多平面重建技术进行检查，但未显示骨折迹象。外伤六周后，患者仍有持续的腕部疼痛。此时手腕的X线和CT扫描显示舟骨陈旧性腰部骨折。遂行髂骨植骨和螺钉内固定手术治疗。
舟骨骨折的早期诊断和对骨折类型的正确描述在治疗中具有重要价值。X线检查结合患腕的CT扫描或MRI扫描被视为诊断标准。报告的病例表明，即使采用轴向平面的薄层CT扫描，舟骨骨折仍可能被漏诊。因此，我们建议在初步X线检查无明显异常后，采用沿舟骨纵轴的斜矢状位薄层CT扫描。如果未显示骨折且临床怀疑仍然存在，则应进行MRI扫描。
