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Journal of Hand Surgery (British and European Volume)
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Articles

The Value of Radiographs and Bone Scintigraphy in Suspected Scaphoid Fracture

A Statistical Analysis

M. M. C. TIEL-VAN BUUL
E. J. R. VAN BEEK
J. J. J. BORM
F. M. GUBLER
A. H. BROEKHUIZEN
E. A. VAN ROYEN

From the Academic Medical Centre, University of Amsterdam, Departments of Nuclear Medicine, Radiodiagnostics and Traumatology, Amsterdam, The Netherlands

Correspondence: Mrs. M. M. C Tiel-van Buul, MD, PhD, Academic Medical Centre, Department of Nuclear Medicine, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands

The role of radiography and bone scintigraphy in the diagnostic management of suspected scaphoid fracture is controversial. Two strategies were compared for patients with initial negative radiographs: repeated radiography versus selective bone scintigraphy.

Using the known positive predictive value of scintigraphy, the sensitivity and specificity of both diagnostic strategies were evaluated in a series of 78 consecutive patients. The kappa value for initial radiographs was 0.76 but decreased to 0.5 for follow-up radiographs. Similarly, sensitivity decreased from 64% to 30% in follow-up radiographs. Specificity of the bone scan was 98%.

The best diagnostic strategy in the management of clinically suspected scaphoid fractures consists of initial radiography followed by bone scintigraphy in patients with negative radiographs.

Journal of Hand Surgery (British and European Volume), Vol. 18, No. 3, 403-406 (1993)
DOI: 10.1016/0266-7681(93)90074-P
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