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Diagnostic Strategy for Suspected Scaphoid Fractures in the Presence of Other Fractures in the Carpal Region

From the Department of Trauma Surgery, Medisch Centrum Haaglanden, The Hague, The Netherlands

Correspondence: Beeres, F.J.P. Medisch, Centrum Haaglanden, Secretariaat Heelkunde, PO Box 432, 2501 CK, The Hague, The Netherlands. Tel.: +31 0 70 330 20 86; fax: +31 0 70 388 98 09. E-mail: f.j.p.beeres{at}umail.leidenuniv.nl

Bone scintigraphy will identify up to 25% of occult scaphoid bone fractures after negative scaphoid X-rays. Consequently, it deserves a place in the diagnostic process of suspected scaphoid fractures. However, the role of bone scintigraphy is less clear if scaphoid X-rays show other fractures in the carpal region. We analysed 111 consecutive patients with a suspected scaphoid fracture on physical examination. Scaphoid X-rays revealed 61 fractures. Fifty-five patients had scaphoid fractures only and six patients had other fractures in the carpal region but no scaphoid fracture. In 50 cases, no bone injury was seen on these X-rays. In three out of the six patients with other fractures in the carpal region, bone scintigraphy revealed four occult concomitant fractures: one scaphoid, one scaphoid and trapezial and one capitate fracture. In conclusion, bone scintigraphy is required when scaphoid X-rays do not confirm a suspected scaphoid fracture, even in the presence of other fractures in the carpal region.

Key Words: scaphoid • diagnosis • multiple carpal injuries • adjacent fracture

Journal of Hand Surgery (British and European Volume), Vol. 31, No. 4, 416-418 (2006)
DOI: 10.1016/J.JHSB.2006.04.007


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