Abnormal scaphoid fat pad: is it a reliable sign of fracture scaphoid

In a retrospective study, initial radiographs of 40 proven cases of scaphoid fractures and 40 cases where fractures of scaphoid were eventually excluded were examined in a 'blinded' fashion. In none of these radiographs was a fracture line demonstrated by people who did not know the outcome. In 4 patients with proven fracture, normal scaphoid fat pads were demonstrated; a 10% 'false negative' result and in 9 patients without fracture, abnormal scaphoid fat pads were seen; a 23% 'false positive' result. The authors conclude that the scaphoid fat pad sign is a poor predictor of scaphoid fracture, even though a positive scaphoid fat pad sign indicates that an underlying fracture is likely.