Objective: To evaluate the role of radionuclide bone scanning in patients with suspected scaphoid trauma, particularly in those with negative radiographs.
Design: Prospective. Radionuclide scans and carpal bone radiography were performed on all participants in the early post-injury period.
Setting: Cape Town tertiary centre trauma unit.
Participants: Fifty patients who presented with clinical features suggestive of scaphoid trauma.
Main outcome measure: Definitive radiographic diagnosis of fracture or persistent clinical features of scaphoid trauma.
Results: All patients who had fractures demonstrated on standard radiography either at the initial visit (13 patients) or at 2 weeks (8 patients) had positive scintiscans (sensitivity 100%). Four of 6 patients who had a positive scan but negative first and second radiographs had persistent tenderness on clinical examination which required extended immobilisation in a plaster cast. The overall positive predictive value of scintigraphy was 93%. All patients with a negative scan were clinically and radiologically negative at 2 weeks (negative predictive value 100%). Evidence of multifocal injury was present in 12 scans, but only 1 radiograph. Thirty-one patients (62%) were scanned within 48 hours of injury.
Conclusion: Bone scintigraphy can be used in radiograph-negative scaphoid area injury to exclude the need for further follow-up reliably, but those with positive scans still require clinical examination and radiography at 2 weeks.