Is there a place for radionuclide bone scintigraphy in the management of radiograph-negative scaphoid trauma?
AbstractObjective. 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 perfonned on aJl participants in the earty 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%. An patients wtth a negative scan were clinically and
radiologically negative at 2 weeks (negative predictive value 100%). Evidence of muttifocaJ 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 A number of studies have shown the importance of bone scintigraphy in the detection of fractures in radiographnegative skeletal trauma.T-3 The early detection and immobilisation of fractures of the scaphoid are thought to be essential in preventing the disabling sequelae of avascular necrosis and pseudo-arthrosis,4 Several studies allude to the
unreliability of plain radiographs in the initial detection of these fractures.5-11 A second radiograph approximately 2 weeks after the first detects a number of fractures missed initially, but probably still does not have 100% sensitivity even at this stage.s It would be very helpful to have a test which, in the first few days, could reliably exclude the need for further radiographic follow-up and interim plaster cast immobilisation. The purpose of this study was to determine the sensitivity, specificity and negative predictive value of early bone scintigraphy in patients with possible scaphoid injury and to make recommendations about its use in emergency units.
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