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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 9, 1205-1209.
doi: 10.1302/0301-620X.90B9.20341  
Copyright © 2008 by British Editorial Society of Bone and Joint Surgery
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Early magnetic resonance imaging compared with bone scintigraphy in suspected scaphoid fractures

F. J. P. Beeres, MD, PhD, Resident of Surgery1; S. J. Rhemrev, MD, Trauma Surgeon1; P. den Hollander, MD, Resident in Orthopaedics1; L. M. Kingma, MD, PhD, Radiologist1; S. A. G. Meylaerts, MD, PhD, Trauma Surgeon1; S. le Cessie, PhD, Statistician2; K. A. Bartlema, MD, Trauma Surgeon2; J. F. Hamming, MD, PhD, Professor, General Surgeon2; and M. Hogervorst, MD, Trauma Surgeon3

1 Medical Centre Haaglanden, Postbus 432, 2501 CK The Hague, The Netherlands.
2 Leiden University Medical Centre, Postbus 9600, 2300 RC Leiden, The Netherlands.
3 Gelre Ziekenhuizen, Postbus 9014, 7300 DS Apeldoorn, The Netherlands.

Correspondence should be sent to Dr F. J. P. Beeres; e-mail: f.j.p.beeres{at}lumc.nl

We evaluated 100 consecutive patients with a suspected scaphoid fracture but without evidence of a fracture on plain radiographs using MRI within 24 hours of injury, and bone scintigraphy three to five days after injury. The reference standard for a true radiologically-occult scaphoid fracture was either a diagnosis of fracture on both MRI and bone scintigraphy, or, in the case of discrepancy, clinical and/or radiological evidence of a fracture.

MRI revealed 16 scaphoid and 24 other fractures. Bone scintigraphy showed 28 scaphoid and 40 other fractures. According to the reference standard there were 20 scaphoid fractures. MRI was falsely negative for scaphoid fracture in four patients and bone scintigraphy falsely positive in eight. MRI had a sensitivity of 80% and a specificity of 100%. Bone scintigraphy had a sensitivity of 100% and a specificity of 90%.

This study did not confirm that early, short-sequence MRI was superior to bone scintigraphy for the diagnosis of a suspected scaphoid fracture. Bone scintigraphy remains a highly sensitive and reasonably specific investigation for the diagnosis of an occult scaphoid fracture.




eLetters:

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Snuffbox tenderness at two weeks does not equate to scaphoid fracture
Onur Berber, et al.
J Bone Joint Surg Br Online, 15 Sep 2008 [Full text]
Authors' reply:
Frank J.P. Beeres, et al.
J Bone Joint Surg Br Online, 16 Oct 2008 [Full text]

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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General