IS THERE A PLACE FOR RADIONUCLIDE BONE-SCINTIGRAPHY IN THE MANAGEMENTOF RADIOGRAPH-NEGATIVE SCAPHOID TRAUMA

Objective. To evaluate the role of radionuclide bone scanning in patie nts with suspected scaphoid trauma, particularly in those with negativ e radiographs. Design. Prospective, Radionuclide scans acid carpal bon e radiography were performed on all participants in the early post-inj ury period. Setting. Cape Town tertiary centre trauma unit. Participan ts. fifty patients who presented with clinical features suggestive of scaphoid trauma. Main outcome measure. Definitive radiographic diagnos is of fracture or persistent clinical features of scaphoid trauma. Res ults. All patients who had fractures demonstrated on standard radiogra phy either at the initial visit (13 patients) or at 2 weeks (8 patient s) had positive scintiscans (sensitivity 100%). Four of 6 patients who had a positive scan but negative first and second radiographs had per sistent tenderness on clinical examination which required extended imm obilisation in a plaster cast. The overall positive predictive value o f scintigraphy was 93%. All patients with a negative scan were clinica lly 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-neg ative scaphoid area injury to exclude the need for further follow-up r eliably, but those with positive scans still require clinical examinat ion and radiography at 2 weeks.