Radiography and scintigraphy of suspected scaphoid fracture. A long-term study in 160 patients

Abstract

Radiographs of the scaphoid after injury are difficult to interpret, and bone scintigraphy is widely used to increase the accuracy of diagnosis, though many fractures suspected on scintigraphy cannot be confirmed radiologically. We have reviewed the clinical consequences, after one year, of managing suspected scaphoid fractures according to the bone-scan results. We studied 160 patients, 35 of whom had initially positive radiographs and were treated in a cast for 12 weeks. The other 125 had bone scintigraphy and were managed according to the result. After a minimum of one year 119 patients were reviewed. Scintigraphically suspected scaphoid fracture could not be confirmed radiologically in 25%. There were no cases of nonunion. The long period of immobilisation in patients with positive radiographs or positive bone scans did not influence the frequency or severity of late symptoms compared with those with a normal bone scan.

Adult Scaphoid Fracture

“…11,75 Another study indicated that traffic accidents accounted for 58% of scaphoid injuries, with sports (20%) and home falls (13%) as the next most common mechanisms. 54 Prior scaphoid fracture diagnostic reviews provide a narrative synopsis of physical examination in the evaluation of wrist injuries, but none provides a systematic review or meta-analysis to quantify diagnostic accuracy. 1,115,116 Without explicitly defined methods for various physical examination maneuvers, significant interspecialty heterogeneity occurs when evaluating for these findings.…”

“…46,[49][50][51][52][53][54] Among the five fat pad studies, four were European, while one did not specify its geographic locale. Two were ED-based and all were retrospective.…”

“…Two studies assessed the accuracy of repeat x-rays. Tiel-van Buul et al 54 retrospectively compared x-rays (at presentation, 14 days postinjury, and 6 weeks) against radionuclide imaging (200 MBq 99m Tc-MDP) performed at an average of 10 days postinjury. Within 3 days of injury, Herneth et al 46 prospectively evaluated "conventional radiology" (posteroanterior, lateral, semipronated oblique scaphoid, radial oblique scaphoid, and posteroanterior views with the wrist in ulnar deviation) with radiologists' high spatial resolution US using MRI (short inversion time inversion recovery, coronal T1-weighted spin-echo, and transverse T2*-weighted three-dimensional gradient-echo sequences) as the criterion standard.…”

A closer look at fracture healing

“…[24][25][26] However, compared to conventional radiography, clinical CT was not substantially better at determining the repair of distal radius fractures. 27 In addition, for research purposes, evaluation of the outcome of distal radius fractures is usually assessed using validated questionnaires, such as the patientrated wrist evaluation (PRWE). 28,29 By the Association of Surgeons of the Netherlands (Nederlandse Vereniging voor Heelkunde, NVvH), the PRWE score is considered as a more important outcome than range of motion or radiological findings.…”

“…26 In short, the cortical and trabecular region were separated fi rst using a semi-automated contouring scheme in which the periosteal boundary surface of the radius was derived. 27 After contouring, a Laplace-Hamming fi lter (epsilon 0.5 and cut-off frequency 0.4) followed by normalization (range 0−1000) and global thresholding (threshold 400), was used in order to extract the voxels that represented mineralized bone and to create the segmented images. The used values were default values specified by the manufacturer and these are consistently used for all HRpQCT scanners.…”