Bone marrow edema in magnetic resonance in scaphoid injury

INTRODUCTION: Post-traumatic bone marrow edema is detected in 36% of patients undergoing wrist magnetic resonance (MRI), and in most cases, it is related to scaphoid fracture. However, the correct attribution of bone marrow edema in an acute setting remains complex. The aim of this study was to gain a better understanding of the origin of acute bone marrow edema in scaphoid injury.EVIDENCE ACQUISITION: All published and unpublished studies on the presence of bone marrow edema in case of scaphoid injury were included. Comprehensive literature searches were conducted (30 June 2020) based on the use of PubMed, Embase, Cochrane and Web of Science database. Potentially relevant articles were selected for full text review. A data extraction worksheet was compiled to acquire and record the observations regarding pathologies related to the presence of bone marrow edema in scaphoid trauma.EVIDENCE SYNTHESIS: The scaphoid is the most fractured carpal bone; on T1- and T2-weighted sequences is seen as a low signal intensity line across the bone with an adjacent marrow edema. In case of disruption of the ligamentous complex holding the scaphoid and lunate together, in the condition called scapholunate (SL) dissociation, MRI reveals bone marrow edema on the carpal-sided of the scaphoid. Bone contusion refers to bone marrow edema without evidence of fractures that occurs in the post-traumatic bone where marrow changes demonstrated on MRI result from a combination of hemorrhage, edema and microtrabecular fractures. The osteochondral lesion represents an osteochondral fracture involving an area of avascular necrosis in the subchondral bone and in the overlying cartilage layer; typical radiographic findings of this condition are sclerosis, fragmentation, erosion and collapse of the proximal pole of the scaphoid, and these findings on MRI are confirmed and classified.CONCLUSIONS: A review of the currently available literature on diagnostic studies of bone marrow edema following scaphoid trauma identified the mode of presentation and associated findings for major underlying diseases. Further studies will be needed to build solid evidence on the clinical usefulness of this information to help identify the appropriate treatment and follow-up pathway.