title: Occult fractures of the waist of the scaphoid: early diagnosis by high-spatial-resolution sonography.
abstract: OBJECTIVE
  This study evaluated the diagnostic accuracy of high-spatial-resolution sonography in the diagnosis of occult fractures of the waist of the scaphoid.
  
  
  METHODS
  Sonography of the scaphoid bone with a 12-MHz transducer was performed in 54 patients with clinically suspected scaphoid fracture and normal findings on initial radiographs, including specific scaphoid images. Three levels of clinical suspicion were considered: high (20%), moderate (30%), and low (50%). Attention was paid to the continuity of the scaphoid cortex and to the surrounding soft tissues (i.e., hemarthrosis or hematoma). Data from early sonograms were then compared with the results of radiography repeated 10-14 days after the initial trauma. In cases of persistent suspicion despite normal findings on follow-up radiographs, the presence of fracture was evaluated on CT (four patients), MR imaging (one patient), or bone scanning (one patient).
  
  
  RESULTS
  Follow-up examinations proved fracture of the scaphoid waist in five patients. In all patients, diagnosis of fracture was suspected on initial sonograms showing cortical disruption associated with soft-tissue abnormalities. There was one false-positive finding and no false-negative results. Using cortical disruption as a diagnostic criterion, we found the sensitivity, specificity, and accuracy of high-resolution sonography for the depiction of scaphoid fracture to be 100%, 98%, and 98%, respectively. Using soft-tissue abnormalities alone as a criterion, we found the sensitivity, specificity, and accuracy of high-resolution sonography to be 100%, 65%, and 68%, respectively. The overall prevalence of occult fracture was 9%, ranging from 3.7% for low suspicion to 27% for high suspicion of fracture.
  
  
  CONCLUSIONS
  High-resolution sonography is a reliable and accurate method of evaluating occult fractures of the scaphoid waist. Cortical disruption is the diagnostic key. Soft-tissue abnormalities alone lack specificity.
authors.affiliation: Service de Radiologie, Groupe Hospitalier Pellegrin, CHRU Bordeaux, Place Amélie Raba Léon, 33076 Bordeaux Cedex, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Hauger
authors.forename: Olivier
authors.initials: O
authors.lastname: Bonnefoy
authors.forename: Maryse
authors.initials: M
authors.lastname: Moinard
authors.forename: Daniel
authors.initials: D
authors.lastname: Bersani
authors.forename: François
authors.initials: F
authors.lastname: Diard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D005596:Fractures, Closed / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D015203:Reproducibility of Results; D021361:Scaphoid Bone / Q000000981:diagnostic imaging* / Q000293:injuries*; D012680:Sensitivity and Specificity; D013997:Time Factors; D014463:Ultrasonography