[The diagnosis of recent scaphoid fractures: review of the literature].
Fractures of the scaphoid are the most common carpal fractures. A review of the literature indicates that the prevalence of the fracture in the case of clinical suspicion is less than 50%. A quality X-ray examination remains essential as an initial diagnostic tool in the evaluation of scaphoid fractures. Its sensitivity varies from 59 to 79%. Patients with negative X-rays present with about 18.7% of scaphoid fractures; 5% of bruised scaphoid; 13% of radius fractures and 7% of miscellaneous bone lesions. If not treated promptly, a scaphoid fracture may be compounded by non-union with associated risk factors such as avascular necrosis and osteoarthritis. Considering these risks, patients with suspected scaphoid fracture with normal X-rays, routinely undergo wrist immobilization until imaging confirms or denies the presence of fracture. Consequently, more than half of the patients undergo wrist immobilization needlessly. This may have a negative impact on their professional life and personal activities while representing a high medical cost. MRI is the imaging technique of choice for suspicious or negatice X-rays. MDCT is less costly than MRI or bone scan, readily available and highly effective for trauma patients but is lacks accuracy and should be used with caution in this indication.
Blum
A
A
Service d'Imagerie Guilloz, CHU, 29, avenue de Lattre-de-Tassigny, 54000 Nancy, France. a.blum@chu-nancy.fr
Sauer
B
B
Detreille
R
R
Zabel
J P
JP
Pierrucci
F
F
Witte
Y
Y
Dap
F
F
D003937:Diagnosis, Differential; D005592:Fracture Fixation; D050723:Fractures, Bone / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D007103:Immobilization; D008279:Magnetic Resonance Imaging; D011542:Pseudarthrosis / Q000175:diagnosis / Q000628:therapy; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000628:therapy; D021361:Scaphoid Bone / Q000293:injuries*; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed; D014954:Wrist Injuries / Q000175:diagnosis* / Q000628:therapy