Is there a place for radionuclide bone scintigraphy in the management of radiograph-negative scaphoid trauma?

OBJECTIVE

To evaluate the role of radionuclide bone scanning in patients with suspected scaphoid trauma, particularly in those with negative radiographs.

DESIGN

Prospective. Radionuclide scans and carpal bone radiography were performed on all participants in the early post-injury period.

SETTING

Cape Town tertiary centre trauma unit.

PARTICIPANTS

Fifty patients who presented with clinical features suggestive of scaphoid trauma.

MAIN OUTCOME MEASURE: Definitive radiographic diagnosis of fracture or persistent clinical features of scaphoid trauma.

RESULTS

All patients who had fractures demonstrated on standard radiography either at the initial visit (13 patients) or at 2 weeks (8 patients) had positive scintiscans (sensitivity 100%). Four of 6 patients who had a positive scan but negative first and second radiographs had persistent tenderness on clinical examination which required extended immobilisation in a plaster cast. The overall positive predictive value of scintigraphy was 93%. All patients with a negative scan were clinically and radiologically negative at 2 weeks (negative predictive value 100%). Evidence of multifocal injury was present in 12 scans, but only 1 radiograph. Thirty-one patients (62%) were scanned within 48 hours of injury.

CONCLUSION

Bone scintigraphy can be used in radiograph-negative scaphoid area injury to exclude the need for further follow-up reliably, but those with positive scans still require clinical examination and radiography at 2 weeks.