Early computed tomography compared with bone scintigraphy in suspected scaphoid fractures

Area of Science:

• Orthopedic surgery
• Radiology
• Emergency medicine

Background:

• Occult scaphoid fractures are challenging to diagnose, often requiring advanced imaging.
• Early diagnosis is crucial to prevent complications like avascular necrosis.

Purpose of the Study:

• To compare the diagnostic efficacy of multidetector computed tomography (CT) versus bone scintigraphy for occult scaphoid fractures.
• To determine if CT offers superior diagnostic accuracy in the early detection of these fractures.

Main Methods:

• 100 patients with suspected scaphoid fractures underwent both CT (within 24 hours) and bone scintigraphy (3-5 days post-injury).
• A reference standard, including follow-up, was used to confirm true fractures.
• Diagnostic performance metrics (sensitivity, specificity, accuracy, PPV, NPV) were calculated for both modalities.

Main Results:

• Bone scintigraphy demonstrated higher sensitivity (93%) and negative predictive value (99%) for scaphoid fractures compared to CT (64% sensitivity, 94% NPV).
• CT showed higher specificity (99%) and positive predictive value (90%) than bone scintigraphy (91% specificity, 62% PPV).
• Overall accuracy was comparable: CT (94%) and bone scintigraphy (91%).

Conclusions:

• This study did not find multidetector computed tomography (CT) to be superior to bone scintigraphy for diagnosing suspected occult scaphoid fractures.
• Bone scintigraphy appears more sensitive in detecting these fractures, while CT offers higher specificity.