Modified carpal box technique in the diagnosis of suspected scaphoid fractures.
OBJECTIVE
To establish and test the clinical efficacy of a new diagnostic algorithm with the extensive utilization of modified carpal box radiography (mX-CB) in the detection of scaphoid fractures.


METHODS
Initial and early follow-up radiographic evaluation of 146 suspected scaphoid fractures were carried out by mX-CB. Patients with unconfirmed diagnosis were referred to CT. Patients were followed for 1 year after injury. Sensitivity, specificity and interobserver agreement of reading mX-CB images were determined statistically.


RESULTS
No non-union or avascular necrosis was seen at 1 year after the injury. 90% of the fractures were diagnosed by mX-CB, only 6.8% of the patients needed referral to CT. Sensitivity of mX-CB at initial presentation was 81.6%. Interobserver agreement was very high among evaluators of mX-CB images.


CONCLUSIONS
Extensive utilization of mX-CB as primary and early follow-up investigation resulted in high initial diagnostic accuracy and low referral rate to a more expensive diagnostic modality.
Toth
F
F
Department of Traumatology, Pécs University, Medical School, Hungary. toth123@yahoo.com
Mester
S
S
Cseh
G
G
Bener
A
A
Nyarady
J
J
Lovasz
G
G
D000328:Adult; D000465:Algorithms; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D015588:Observer Variation; D011237:Predictive Value of Tests; D011859:Radiography / Q000379:methods; D021361:Scaphoid Bone / Q000293:injuries*; D012680:Sensitivity and Specificity; D014954:Wrist Injuries / Q000000981:diagnostic imaging