Early computerized tomography accurately determines the presence or absence of scaphoid and other fractures.
OBJECTIVE
To validate the use of early CT in predicting scaphoid fracture and other fractures in patients with suspected scaphoid fracture.


METHODS
A prospective observational study of adult patients with a diagnosis of clinical scaphoid fracture presenting to a regional ED. Patients were immobilized in a scaphoid plaster and had a CT (wrist and carpals) same or next day. The gold standard used was the diagnosis on Day 10 with clinical examination and X-rays, with MRI performed in patients with persistent tenderness but normal X-rays.


RESULTS
Forty-seven patients completed the study protocol from September 2004 until February 2006. For all fractures, early CT had a 96.8% negative predictive value and 100% positive predictive value (94.4% sensitive, 100% specific). No scaphoid fracture was missed by early CT. One patient had a trapezium fracture on CT, with a coexistent subtle capitate fracture only detected on MRI.


CONCLUSIONS
Early CT scans show promise in the diagnosis of scaphoid and other fractures of the wrist and carpals. Further study is warranted to validate early CT in clinical scaphoid fracture as an alternative to other early advanced imaging, or plaster immobilization and 2 week review.
Cruickshank
Jaycen
J
Emergency Department, Ballarat Health Services, Ballarat, Victoria, Australia. jaycenc@bhs.org.au
Meakin
Alex
A
Breadmore
Ross
R
Mitchell
David
D
Pincus
Steven
S
Hughes
Thomas
T
Bently
Bronwyn
B
Harris
Mark
M
Vo
Austin
A
D042241:Early Diagnosis; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D021361:Scaphoid Bone / Q000000981:diagnostic imaging* / Q000293:injuries*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*