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Le diagnostic des fractures récentes du scaphoïde : revue de la littératureThe diagnosis of recent scaphoid fractures: Review of the literature

https://doi.org/10.1016/S0221-0363(07)91342-6Get rights and content

Résumé

Les fractures du scaphoïde sont fréquentes. L’étude de la littérature montre que, devant une suspicion clinique de fracture du scaphoïde, la prévalence de cette lésion estinférieure à 50 %. Un bilan radiographique standard de qualité doit rester la première étape diagnostique. Il détecte les fractures du scaphoïde avec une sensibilité variant entre 59 et 79 %. Les patients avec des radiographies normales ont en moyenne une fracture du scaphoïde dans 18,7 % des cas, une contusion du scaphoïde dans 5 % des cas, une fracture du radius dans 13 % des cas et une autre fracture dans 7 % des cas. Une fracture du scaphoïde mal traitée conduit à des complications dont le retentissement professionnel et sociétal est élevé. Dans la stratégie classique, pour prévenir ce risque, les patients présentant une suspicion de fracture du scaphoïde dont le bilan radiographique initial est normal bénéficient d’une immobilisation pendant 10-15 jours, voire 6 semaines. Plus de 50 % de ces patients subissent donc une immobilisation et un arrêt de travail inutiles. L’IRM représente la méthode diagnostique idéale en cas de radiographies normales ou douteuses. Le scanner volumique présente une précision plus faible que l’IRM et son analyse doit rester prudente.

Abstract

Fractures of the scaphoid are the most common carpal fractures. A review of the literature indicates that the prevalence of the fracture in the case of clinical suspicion is less than 50%. A quality X-ray examination remains essential as an initial diagnostic tool in the evaluation of scaphoid fractures. Its sensitivity varies from 59 to 79%. Patients with negative X-rays present with about 18.7% of scaphoid fractures; 5% of bruised scaphoid; 13% of radius fractures and 7% of miscellaneous bone lesions. If not treated promptly, a scaphoid fracture may be compounded by non-union with associated risk factors such as avascular necrosis and osteoarthritis. Considering these risks, patients with suspected scaphoid fracture with normal X-rays, routinely undergo wrist immobilization until imaging confirms or denies the presence of fracture. Consequently, more than half of the patients undergo wrist immobilization needlessly. This may have a negative impact on their professional life and personal activities while representing a high medical cost.

MRI is the imaging technique of choice for suspicious or negatice X-rays. MDCT is less costly than MRI or bone scan, readily available and highly effective for trauma patients but is lacks accuracy and should be used with caution in this indication.

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