Clinical utility of tomosynthesis in suspected scaphoid fracture. A pilot study

Abstract

Radiography alone will not detect all scaphoid fractures. There is a reported prevalence between 9 and 33% of occult scaphoid fractures. The evidence-based literature suggests that magnetic resonance imaging (MRI) is the most suitable secondary imaging modality due to the ability to evaluate the bone marrow directly and to also identify other injuries. However, there is no consensus on the choice of follow-up imaging strategy-computed tomography, MRI, or bone scan-across different institutions. Tomosynthesis is a new digital tomographic method creating multiple thin tomographic sections. The purpose of this study was to evaluate the clinical utility of tomosynthesis in suspected occult fracture. Thirty-five patients with a clinically suspected occult scaphoid fracture after initial normal radiography were imaged with repeat radiography and tomosynthesis scan 2weeks after trauma. Repeat radiography revealed one previously undetected scaphoid tubercle avulsion and one scaphoid waist fracture, confirmed by tomosynthesis. Tomosynthesis revealed two additional scaphoid waist fractures. In total, three initially occult scaphoid waist fractures were detected (9%). No additional fractures were detected in the remaining 32 patients during a 1-year follow-up. Tomosynthesis can demonstrate occult scaphoid fractures not visible at radiography.