Abstract
The aim of this study was to evaluate the number and distribution of fractures around the wrist found on bone scintigraphy in patients with a clinically suspected scaphoid fracture and negative initial radiographs. We retrospectively included 445 consecutive patients with a suspected scaphoid fracture who underwent routine bone scintigraphy. None of the radiographs showed evidence of a fracture. We analyzed the type and number of other fractures incidentally found on bone scintigraphy. On average, bone scintigraphy was done in 4 days (1 - 9). The outcome of bone scintigraphy: 80 (18.0%) a scaphoid fracture, 145 (32.6%) another fracture in the carpal region, 208 (46.7%) normal and the diagnosis of 12 (2.8%) was unclear. In the present study, we demonstrated that in patients with a clinically suspected scaphoid fracture and negative initial radiographs, bone scintigraphy detected in many cases (64.4%) other fractures in the carpal region. This suggests that radiographs not only miss scaphoid but also many other carpal and distal radius fractures. Solutions should be found to solve this problem and probably advanced imaging techniques like CT, MRI or bone scintigraphy should be used in the correct clinical scenario.
Highlights
Fractures in and around the wrist are common [1]
The aim of this study was to evaluate the number and distribution of fractures around the wrist found on bone scintigraphy in patients with a clinically suspected scaphoid fracture and negative initial radiographs
We demonstrated that in patients with a clinically suspected scaphoid fracture and negative initial radiographs, bone scintigraphy detected in many cases (64.4%) other fractures in the carpal region
Summary
Fractures in and around the wrist are common [1]. The evaluation of patients with wrist injuries is a diagnostic challenge. In many cases the clinical examination does not provide diagnostic certainty and radiographs traditionally used in the initial investigation might be negative as some fractures are often occult on X-rays [2,3]. Injuries of the wrist lead to high morbidity and disability. Detection and treatment for example of a scaphoid fracture is important to prevent long term complications such as non-union, osteonecrosis, carpal instability and osteoarthropathy. If a fracture is suspected, there is a need for a fast and reliable diagnostic method. Bone scintigraphy has been used in diagnosing fractures at all sites since the 1960s [4]
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