Early Computed Tomography Compared With Bone Scintigraphy in Suspected Scaphoid Fractures

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Purpose:This study examined whether multidetector computed tomography (CT) is superior to bone scintigraphy for diagnosis of an occult scaphoid fracture.Methods and Materials: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%.Conclusion:This study could not confirm that early CT imaging is superior to bone scintigraphy for suspected scaphoid fractures.

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