Height-To-Length Ratios Obtained by Wrist Radiography to Assess Scaphoid Malunion: Radiographic and Clinical Outcomes of 32 Cases

BEZİRGAN U., Özylldlran M., Acar E., YOĞUN Y., Erdoǧan Y., ARMANGİL M.

Journal of Musculoskeletal Research, 2024 (Scopus) identifier

  • Publication Type: Article / Article
  • Publication Date: 2024
  • Doi Number: 10.1142/s0218957724500015
  • Journal Name: Journal of Musculoskeletal Research
  • Journal Indexes: Scopus, Academic Search Premier, BIOSIS, SportDiscus
  • Keywords: Height to Length Ratio (H/L ratio), Radiographic Measurement, Scaphoid Malunion, Wrist Radiography
  • Ankara University Affiliated: Yes


Purpose: Scaphoid nonunion and malunion can be observed after scaphoid fracture. While the diagnosis of nonunion is well defined in the literature, there is no consensus on the diagnostic criteria and clinical outcomes of scaphoid malunion. The aim of the study is to define the direct radiography parameters of scaphoid malunion and determine the clinical outcomes. Methods: Patients applied to our clinic with the diagnosis of scaphoid fracture between January 2020 and June 2021, and were analyzed retrospectively. 32 patients treated with surgical or conservative methods were included in the study. Nonunions and cases with a follow-up period of less than 12 months were excluded. Scapholunate (SL) angles and height-To-length (H/L) ratios of scaphoid were measured on wrist radiography to assess scaphoid malunion. Malunion was defined as SL angle >60° and ROC analysis was applied to determine cutoff H/L ratio in wrist radiography. Wrist functionality and pain were evaluated with the Patient-Rated Wrist Evaluation (PRWE) and MAYO scores. The range of motion (ROM) and grip strength were also recorded. Results: Seventeen patients (53.1%) underwent surgery while conservative treatment was applied to the other 15 (46.9%). Of these, six patients (18.8%) met the definition of malunion. According to receiver operating curve (ROC) analysis, the cutoff H/L ratio in posteroanterior wrist radiographs was 0.602 (p < 0.001) and the cutoff H/L ratio in lateral wrist radiographs was 0.692 (p = 0.003). The ROM values for flexion/extension and radial/ulnar deviation was smaller in the malunion group (p = 0.023 and P = 0.014, respectively). However, no significant difference was observed in pronation/supination values (p > 0.05). Mean MAYO score was 75.0 in malunion group and 90.0 in nonmalunion group (p = 0.003). While the mean PRWE value was 24.50 in malunion, it was 14.15 in nonmalunion (p = 0.023). Conclusion: Evaluation of H/L ratio in wrist radiography provides valuable information in the diagnosis of scaphoid malunion. Scaphoid malunions have poorer functional outcomes.