title: Early computed tomography compared with bone scintigraphy in suspected scaphoid fractures.
abstract: OBJECTIVE
  This study examined whether multidetector computed tomography (CT) is superior to bone scintigraphy for diagnosis of an occult scaphoid fracture.
  
  
  METHODS
  In a study period of 22 months, 100 consecutive patients with a clinically suspected scaphoid fracture and no fracture on scaphoid radiographs, were evaluated with CT within 24 hours after injury and bone scintigraphy between 3 and 5 days after injury. The reference standard for a true (radiographic occult) scaphoid fracture was either (1) diagnosis of fracture on both CT and bone scintigraphy or (2) in case of discrepancy, clinical and/or radiographic evidence of a fracture during follow-up.
  
  
  RESULTS
  CT showed 10 scaphoid and 18 other fractures. Bone scintigraphy showed 21 scaphoid and 36 other fractures. According to the reference standard, there were 14 scaphoid fractures. CT had a sensitivity of 64%, specificity of 99%, accuracy of 94%, a positive predictive value of 90%, and a negative predictive value of 94%. Bone scintigraphy had a sensitivity of 93%, specificity of 91%, accuracy of 91%, a positive predictive value of 62%, and a negative predictive value of 99%.
  
  
  CONCLUSIONS
  This study could not confirm that early CT imaging is superior to bone scintigraphy for suspected scaphoid fractures.
authors.affiliation: Department of Surgery, Medical Centre Haaglanden, The Hague, The Netherlands. s.rhemrev@mchaaglanden.nl
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Rhemrev
authors.forename: Andele D
authors.initials: AD
authors.lastname: de Zwart
authors.forename: Lucas M
authors.initials: LM
authors.lastname: Kingma
authors.forename: Sven A G
authors.initials: SA
authors.lastname: Meylaerts
authors.forename: Jan-Willem
authors.initials: JW
authors.lastname: Arndt
authors.forename: Inger B
authors.initials: IB
authors.lastname: Schipper
authors.forename: Frank J P
authors.initials: FJ
authors.lastname: Beeres
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000293:injuries*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D055815:Young Adult