Fifteen minutes bone scintigraphy in patients with clinically suspected scaphoid fracture and normal x-rays

Bayer, Lasse; Widding, Alice; Diemer, H. P.

doi:10.1016/s0020-1383(99)00280-6

Cited by 27 publications

(14 citation statements)

References 26 publications

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“…Bone scanning, which is more sensitive and more specific, has been advocated by many as an alternative to immobilization and follow-up [10][11][12][13][14]. The cost at our institution ($639) would approach that of unnecessary clinical imaging and therapeutic follow-up (Tables 3 and 4).…”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of Immediate MR Imaging Versus Traditional Follow-Up for Revealing Radiographically Occult Scaphoid Fractures

Dorsay

Major²,

Helms³

2001

American Journal of Roentgenology

157

141

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Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of Immediate MR Imaging Versus Traditional Follow-Up for Revealing Radiographically Occult Scaphoid Fractures

Dorsay

Major²,

Helms³

2001

American Journal of Roentgenology

157

141

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“…22 It is only a small minority 23 or none 6 of suspected scaphoid fractures became visible radiologically after a period of immobilisation, suggesting that repeat radiographs after 2-3 weeks do not necessarily lead to improved diagnostic accuracy. 7 As a result, early bone scintigraphy has been recommended to increase the accuracy of diagnosis of scaphoid fractures 18,[24][25][26][27] as its sensitivity approaches 100%, 25,27 and specificity 98%. 22 However, bone scintigraphy is expensive, and the question as to when to perform bone scintigraphy also remains controversial.…”

Section: Radiological Investigationmentioning

confidence: 99%

Management of suspected scaphoid fractures in accident and emergency departments – time for new guidelines

Tai

Ramachandran²,

McDermott³

et al. 2005

Ann R Coll Surg Engl

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INTRODUCTION The objectives of this work were to assess the clinical knowledge of clinicians in the accident and emergency (A&E) departments in England & Wales and evaluate the current trend for the acute management of radiologically normal, but clinically suspected, fractures of the scaphoid.SUBJECTS AND METHODS We conducted a telephone survey on 146 A&E senior house officers (SHOs) in 50 different hospitals. This survey assessed the clinicians' experience, their clinical and radiological diagnostic methods, and their initial treatment of suspected scaphoid fractures. RESULTS The majority (55.8%) of SHOs performed only one clinical test to diagnose suspected scaphoid fractures. Overall, 41% were unable to cite the number of the radiographic views taken and only 10% of departments have direct access to further radiological investigation. There is wide variation in the early treatment of this injury, with the scaphoid cast used most commonly (46%). The majority of SHOs (89%) were unable to describe the features of immobilisation. The mean follow-up period was 10 days, and 53% of cases were followed-up by the senior staff in A&E. Of SHOs, 54% were not aware of any local guidelines for the management of suspected scaphoid fractures in their departments, and 92% were not aware of the existence of the 1992 British Association for Accident and Emergency Medicine (BAEM) guidelines. CONCLUSIONS The clinical knowledge and the management of suspected scaphoid fractures in A&E are unsatisfactory. We, therefore, suggest that the dissemination of up-to-date guidelines could help to educate clinicians to provide better care to the patients.

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“…It is generally accepted that advanced imaging modalities are needed in case of suspected scaphoid fractures and negative radiographs in order to rule out a scaphoid fracture. It is known that missed diagnosis and inadequate treatment of this fracture leads to nonunion and may cause pain and serious disability [7,[10][11][12][13][14]. However, little is known on the clinical consequence of missing those other fractures which are detected in this study.…”

Section: Discussionmentioning

confidence: 81%

“…Bone scintigraphy has a sensitivity of up to 100% and a specificity of approximately 85% [7,20,[23][24][25][26]. In addition, according to several reviews, a negative bone scan virtually excludes a scaphoid fracture.…”

Section: Discussionmentioning

confidence: 99%

“…Patients who visited the Emergency Department with an acute trauma and a suspected scaphoid fracture after physical examination but no evidence of a scaphoid fracture on plain radiographs underwent at our institution bone scintigraphy [5][6][7][8][9][10][11]. We noticed that bone scintigraphy detected many other occult carpal and distal radius fractures in these patients with a suspected scaphoid fracture.…”

Section: Introductionmentioning

confidence: 99%

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Occult Fractures in the Carpal Region: Incidental Findings on Bone Scintigraphy

Zoakman¹,

Leerdam²,

Beeres³

et al. 2013

OJO

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The aim of this study was to evaluate the number and distribution of fractures around the wrist found on bone scintigraphy in patients with a clinically suspected scaphoid fracture and negative initial radiographs. We retrospectively included 445 consecutive patients with a suspected scaphoid fracture who underwent routine bone scintigraphy. None of the radiographs showed evidence of a fracture. We analyzed the type and number of other fractures incidentally found on bone scintigraphy. On average, bone scintigraphy was done in 4 days (1 -9). The outcome of bone scintigraphy: 80 (18.0%) a scaphoid fracture, 145 (32.6%) another fracture in the carpal region, 208 (46.7%) normal and the diagnosis of 12 (2.8%) was unclear. In the present study, we demonstrated that in patients with a clinically suspected scaphoid fracture and negative initial radiographs, bone scintigraphy detected in many cases (64.4%) other fractures in the carpal region. This suggests that radiographs not only miss scaphoid but also many other carpal and distal radius fractures. Solutions should be found to solve this problem and probably advanced imaging techniques like CT, MRI or bone scintigraphy should be used in the correct clinical scenario.

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Fifteen minutes bone scintigraphy in patients with clinically suspected scaphoid fracture and normal x-rays

Cited by 27 publications

References 26 publications

Cost-Effectiveness of Immediate MR Imaging Versus Traditional Follow-Up for Revealing Radiographically Occult Scaphoid Fractures

Cost-Effectiveness of Immediate MR Imaging Versus Traditional Follow-Up for Revealing Radiographically Occult Scaphoid Fractures

Management of suspected scaphoid fractures in accident and emergency departments – time for new guidelines

Occult Fractures in the Carpal Region: Incidental Findings on Bone Scintigraphy

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