Early computed tomography compared with bone scintigraphy in suspected scaphoid fractures

This study examined whether multidetector computed tomography (CT) is superior to bone scintigraphy for diagnosis of an occult scaphoid fracture.

In a study period of 22 months, 100 consecutive patients with a clinically suspected scaphoid fracture and no fracture on scaphoid radiographs, were evaluated with CT within 24 hours after injury and bone scintigraphy between 3 and 5 days after injury. The reference standard for a true (radiographic occult) scaphoid fracture was either (1) diagnosis of fracture on both CT and bone scintigraphy or (2) in case of discrepancy, clinical and/or radiographic evidence of a fracture during follow-up.

CT showed 10 scaphoid and 18 other fractures. Bone scintigraphy showed 21 scaphoid and 36 other fractures. According to the reference standard, there were 14 scaphoid fractures. CT had a sensitivity of 64%, specificity of 99%, accuracy of 94%, a positive predictive value of 90%, and a negative predictive value of 94%. Bone scintigraphy had a sensitivity of 93%, specificity of 91%, accuracy of 91%, a positive predictive value of 62%, and a negative predictive value of 99%.

This study could not confirm that early CT imaging is superior to bone scintigraphy for suspected scaphoid fractures.