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Theme: Inclusion and Collaboration Theme: Inclusion and Collaboration

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Do CT Scans Oriented Along The Longitudinal Scaphoid Axis Change Surgical Management Of Scaphoid Fractures?
Adnan N Cheema, MD; Paul Niziolek, MD, PhD; David R Steinberg, MD; Bruce Kneeland, MD; Nikolas H Kazmers, MD MSE; Oded Ben-Amotz, MD; David J. Bozentka, MD
University of Pennsylvania, Philadelphia, PA

Introduction:  Reformatting CT scans along the scaphoid longitudinal axis improves the ability to detect scaphoid fractures, as compared to reformats along the wrist axis. However, it remains unclear whether scaphoid axis reformats affect measurements of displacement or deformity, which drive the decision to perform surgery. Our primary null hypothesis was that reformatting CT scans along the scaphoid axis does not affect measurements of fracture displacement and deformity. Our secondary null hypothesis was that resulting measurements would not lead to different surgical recommendations.

Material and Methods:  30 consecutive adult patients with CT scans from April 2011 to August 2016 demonstrating scaphoid fractures were identified in an online database. Each original CT scan was then re-formatted along two axes: the longitudinal axis of the scaphoid and the transverse axis of the wrist.  The reformatted scans were sent to two radiologists and two orthopedic surgeons who independently made the following measurements in a random, blinded fashion: 1) fracture gap 2) displacement of the articular surface3 ) intrascaphoid angle and 4) height-to-length ratio

Results:  The precision of each of the above measurements was compared between the two axes using Intraclass Correlation Coefficients (ICC) and associated 95% confidence intervals. No statistically significant difference was found for any of the measurements between the two axes. These results are summarized as follows.

Each scaphoid CT was assigned a designation of "Requires Surgery" if any one of the following cutoffs was met: fracture gap >1mm, articular displacement >1mm, intrascaphoid angle >35, or height-to-length ratio >0.65. The results are summarized as follows.

The determination of surgery based on wrist versus scaphoid axes was compared using McNemar's test. A two-tailed p value of 0.211 was obtained, showing no statistical significance.

Conclusions: Reformatting CT scans in line with the scaphoid does not result in more precise measurements of fracture gap, articular displacement, height-to-length ratio, or intrascaphoid angle. Furthermore, reformatting CT scans along the longitudinal axis of the scaphoid does not change surgical management of scaphoid fractures when compared to those fractures assessed in the wrist axis.

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