CARPAL BOX RADIOGRAPHY IN SUSPECTED SCAPHOID FRACTURE

We have assessed the value of using a simple apparatus, the Carpal Box , in patients with suspected scaphoid fracture, to produce elongated a nd magnified radiographs of the carpus. The interobserver agreement be tween 60 observers of standard scaphoid radiographs and longitudinal a nd transverse Carpal Box radiographs (X-CB) was compared in 11 patient s. Three-phase bone scanning was used as a comparative standard, If at least 75% of the observers agreed and the result was confirmed by thr ee-phase bone scanning, the outcome was termed reliable,Scaphoid radio graphs and the longitudinal X-CB films were reliable in four patients and the transverse X-CB films in six patients. The bone scan suggested a scaphoid fracture in five of the 11 patients. Agreement in the inte rpretation of the standard scaphoid radiographs was acceptable in only 36% of patients: in interpretation of transverse Carpal Box radiograp hs this figure increased to 55%.