Radiographs Scaphoid

Fig. 2 27a-e. Scaphoid bone, a PA scaphoid with ulna deviation, b Lateral wrist, c 45° Oblique scaphoid with ulna deviation, d 35°angled PA scaphoid view with ulna deviation, e Resultant Radiographs... 

With acute paediatric trauma, standard radiographs remain the predominant imaging modality, with MRI being used as an adjunct. MRI is useful in detecting some acute injuries such as scaphoid fractures. In other circumstances it is of limited value, being relatively insensitive in detecting small os-sific fragments within a joint and when there is a considerable amount of metallic hardware within the bone. 

Fig. 5.10. Oblique coronal STIR image of the scaphoid. There is extensive marrow oedema with fluid around the carpal bones, features in keeping with a scaphoid fracture. Radiographs were normal.

The scaphoid is the most common site of occult fractures in the wrist area, with up to 20-25% of cases unnoticed at the initial evaluation (Waizenegger et al. 1994). When the diagnosis is delayed, scaphoid fi actures have high rates of complications such as pseudoarthrosis, avascular necrosis of the proximal pole of the bone and secondary radiocarpal osteoarthritis with chronic pain and impaired function. A variety of diagnostic modalities, such as additional radiographic views, bone scan, CT and MR imaging, have been advocated for early detection of scaphoid fractures. The choice between an addi-... 

Fig. 10.80 a-c. Scaphoid fracture, a Coronal 12-5 MHz US image over the lateral aspect of the wrist with corresponding b diagram and c anteroposterior radiographic correlation displays a fracture of the waist of the scaphoid as a step-off deformity of the hyperechoic cortical line (open arrow). Note a perilesional hypoechoic halo (arrowheads) surrounding the fracture site, consistent with a local hematoma. Rad, radius... 

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