Investigation of computed tomographic scan concurrent criterion validity in doubtful scaphoid fracture of the wrist.
BACKGROUND
Rapid diagnosis of scaphoid bone fracture in the wrist is important so that appropriate treatment can be started. If a fracture is clinically suspected without being visible on radiography, further investigation has to be conducted to reveal a fracture or to rule it out. The objective of this study was to investigate the validity of computed tomographic (CT) scanning and bone scintigraphy compared with the clinical fracture rate during follow-up of 1 year for examining patients with a suspected scaphoid fracture.


METHODS
Bone scintigraphy and CT scanning were performed in 29 patients with persistent clinical suspicion of a scaphoid bone fracture 5 to 10 days after trauma.


RESULTS
The sensitivity, specificity, and positive and negative predictive values of the CT scan were 100%. The sensitivity, specificity, and positive and negative predictive values of bone scintigraphy were 78%, 90%, 78%, and 90%, respectively. Seven patients showed a fracture on both CT scanning and bone scintigraphy. Eighteen patients showed no fracture on both CT scanning and bone scintigraphy. A false-positive bone scintigram showed up in two patients and a false-negative bone scintigram in another two patients.


CONCLUSIONS
CT scanning is a rapid, simple, valid method for demonstrating or ruling out a scaphoid fracture and is superior to bone scintigraphy.
Breederveld
R S
RS
Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands. rbreederveld@rkz.nl
Tuinebreijer
W E
WE
D000328:Adult; D000368:Aged; D002370:Casts, Surgical; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging / Q000379:methods*; D021361:Scaphoid Bone / Q000293:injuries*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D014954:Wrist Injuries / Q000000981:diagnostic imaging* / Q000628:therapy