Role of early CT scan in diagnosis of occult scaphoid fractures- a prospective study

Authors

  • Omeshwar Singh Department of Orthopedic, Government Medical College, Jammu, Jammu and Kashmir, India
  • Anuradha Sen Department of Anesthesia, Government Medical College, Jammu, Jammu and Kashmir, India
  • Sumeet Singh Charak Department of Orthopedic, Government Medical College, Jammu, Jammu and Kashmir, India
  • Shakeel Ahmad Department of Orthopedic, Sharda Hospital, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20173985

Keywords:

Clinical scaphoid, CT scan, Occult fracture

Abstract

Background: Wrists injuries are one of the common presentations to emergency departments and orthopaedic clinics. The scaphoid bone is the most commonly injured of the carpal bones accounting for 50-80% of carpal injuries and predominantly occurs in young healthy individuals. Scaphoid fractures are the most problematic to diagnose in a clinical setting because it can take up to 6 weeks for scaphoid fractures to become conclusive on plain X-ray films. Aim of the study was to retrospective study was carried out to study the role of early CT scan in diagnosis of occult scaphoid fractures.

Methods: A total of 123 patients presented with an acute wrist injury with subsequent signs of scaphoid injury in the absence of a diagnostic fracture on plain X-ray within the time period from June 2014 to May 2016 in a tertiary care centre.

Results: This study shows that 31% of normal X-rays were pathological on CT scan and out of these; scaphoid fractures (74% of pathologies) represent a large number of patients with fractures that were missed by initial plain films.

Conclusions: This study shows an extremely high false-negative rate for plain X-rays and advocate CT at the first attendance to fracture clinic if there is suspicion of scaphoid injury. An earlier diagnosis leads to appropriate management and reduces restrictions to the patient in terms of prolonged immobilization and repeated clinical reviews.

References

Larsen CF, Brodum V, Skov O. Epidemiology of scaphoid fractures in Odense, Denmark. Acta Orthop Scand. 1992;63:216-20.

Mehta M, Brautigan MW. Fracture of carpal navicular. Efficacy of clinical findings and improved diagnosis of six view radiography. Ann Emerg Med. 1990;19:225-31.

Cooney WP, Linscheid RI, Dobyns JH. Fractures and distortion of the wrist. In: Rockwood CA, editor. Fractures in adult. Philadelphia, PA: Lippincott-Raven; 1996:755-767.

Waizengger M, Barton NJ, David TR, Waistie ML. Clinical signs in scaphoid fractures. J Hand Surg Br. 1994;19:743-6.

Dorsay TA, Major NM, Helms CA. Cost-effectiveness of immediate MR imaging versus traditional follow-up for revealing radiographically occult scaphoid fracture. Am J Radiol. 2001;177:1257-63.

H erneth AM, Siegmeth A, Bader TR, Ba-Ssalamah A, Lechner G, Metz VM, et al. Scaphoid fractures: evaluation with high-spatial-resolution US initial results. Radiol. 2001;220:231-5.

Leslie IJ, Dickson RA. The fractured carpal scaphoid. Natural history and factors influencing outcome. J Bone Joint Surg Br. 1981;63:225-30.

Dias JJ, Brenkel IJ, Finlay DB. Patterns of non-union in fractures in the waist of scaphoid. J Bone Joint Surg Br. 1989;71:307-10.

Lindstrom G, Nystrom A. Natural history of scaphoid non-union, with special reference to ‘asymptomatic’ cases. J Hand Surg Br. 1993;18:403-6.

Tiel-van Buul MM, Van Beek EJ, Broekhuizen AH, Nooit-Gedacht EA, Davids PH, Bakker AJ. Diagnosing scaphoid fractures: radiographs cannot be used as gold standard! Injury. 1992;23:77-9.

Brooks S, Cicuttini FM, Lim S, Taylor D, Stuckey SL, Wluka AE. Cost effectiveness of adding magnetic resonance imaging to the usual management of suspected scaphoid fractures. Br J Sports Med. 2005;39:75-9.

Dorsay TA, Major NM, Helms CA. Cost-effectiveness of immediate MR imaging versus traditional follow-up for revealing radiographically occult scaphoid fractures. AJR Am J Roentgenol. 2001;177:1257-63.

Pillai A, Jain M. Management of clinical fractures of the scaphoid: results of an audit and literature review. Eur J Emerg Med. 2005;12:47-51.

Kukla C, Gaebler C, Breitenseher MJ, Trattnig S, Vecsei V. Occult fractures of the scaphoid: the diagnostic usefulness and indirect economic repercussions of radiography versus magnetic resonance scanning. J Hand Surg Br. 1997;22:810-3.

Nielsen PT, Hedeboe J, Thommesen P. Bone scintigraphy in the evaluation of fracture of the carpal scaphoid bone. Acta Orthop Scand. 1983;54:303-6.

Gabler C, Kukla C, Breitenseher MJ, Trattnig S, Vecsei V. Diagnosis of occult scaphoid fractures and other wrist injuries: are repeated clinical examinations and plain radiographs still state of the art? Langenbecks Arch Surg. 2001;386:150-4.

Tiel-van Buul MM, Van Beek EJ, Borm JJ, Gubler FM, Broekhuizen AH, van Royen EA. The value of radiographs and bone scintigraphy in suspected scaphoid fracture. A statistical analysis. J Hand Surg Br. 1993;18:403-6.

Toth F, Mester S, Cseh G, Bener A, Nyarady J, Lovasz G. Modified carpal box technique in the diagnosis of suspected scaphoid fractures. Acta Radiol. 2003;44:319-25.

Breederveld RS, Tuinebreijer WE. Investigation of computed tomographic scan concurrent criterion validity in doubtful scaphoid fracture of the wrist. J Trauma. 2004;57:851-4.

Brydie A, Raby N. Early MRI in the management of clinical scaphoid fracture. Br J Radiol. 2003;76:296-300.

Plancher KD. Methods of imaging the scaphoid. Hand Clin. 2001;17:703-6.

Pillai A, Jain M. Management of clinical fractures of the scaphoid: results of an audit and literature review. Eur J Emerg Med. 2005;12:47-51.

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Published

2017-08-26

How to Cite

Singh, O., Sen, A., Charak, S. S., & Ahmad, S. (2017). Role of early CT scan in diagnosis of occult scaphoid fractures- a prospective study. International Journal of Research in Medical Sciences, 5(9), 4072–4076. https://doi.org/10.18203/2320-6012.ijrms20173985

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Original Research Articles