Occult Fractures in the Carpal Region: Incidental Findings on Bone Scintigraphy

Sahel Zoakman, Roderick van Leerdam, Frank Beeres, Steven Rhemrev

Department of Surgery, Groene Hart Ziekenhuis, Gouda, The Netherlands.
Department of Surgery, Medisch Centrum Haaglanden, The Hague, The Netherlands.
Department of Surgery, Medisch Centrum Haaglanden, The Hague, The Netherlands..
Emergency Department, Het R?pke-Zweers Ziekenhuis, Hardenberg, The Netherlands.

DOI: 10.4236/ojo.2013.31007                

Abstract

The aim of this study was to evaluate the number and distribution of fractures around the wrist found on bone scintigraphy in patients with a clinically suspected scaphoid fracture and negative initial radiographs. We retrospectively included 445 consecutive patients with a suspected scaphoid fracture who underwent routine bone scintigraphy. None of the radiographs showed evidence of a fracture. We analyzed the type and number of other fractures incidentally found on bone scintigraphy. On average, bone scintigraphy was done in 4 days (1 - 9). The outcome of bone scintigraphy: 80 (18.0%) a scaphoid fracture, 145 (32.6%) another fracture in the carpal region, 208 (46.7%) normal and the diagnosis of 12 (2.8%) was unclear. In the present study, we demonstrated that in patients with a clinically suspected scaphoid fracture and negative initial radiographs, bone scintigraphy detected in many cases (64.4%) other fractures in the carpal region. This suggests that radiographs not only miss scaphoid but also many other carpal and distal radius fractures. Solutions should be found to solve this problem and probably advanced imaging techniques like CT, MRI or bone scintigraphy should be used in the correct clinical scenario.

Keywords

Wrist Injury; Carpal Fractures; Bone Scintigraphy; Scaphoid Fracture; Scaphoid Radiographs

Conflicts of Interest

The authors declare no conflicts of interest.

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