Fifteen minutes bone scintigraphy in patients with clinically suspected scaphoid fracture and normal x-rays

Occult fractures of the scaphoid bone occur frequently and may lead to non- union. The use of three-phase bone scintigraphy in patients with normal x-r ays of the scaphoid after carpal injury is widely advocated. In this study, 40 patients with negative radiographs but clinically suspect ed scaphoid fracture, all had rapid bone scintigraphy with images taken 15 min after intravenous injection of 99 m-Technetium Hydroxymethylene diphosp honate. The scan was performed approximately 2 weeks after the trauma. We f ound 8 fractures of the scaphoid bone and 13 fractures of other carpal bone s. In 5 cases the images were inconclusive. At follow-up 6 months to 2 year s later we found no patients with non-union. We find this rapid version of the bone scan useful as a second line investi gation for continuing wrist pain following trauma in the presence of normal radiography. This can result in a reduction in both lime and costs require d for the diagnostic process. If the results are inconclusive we recommend a delayed image. CT or MRI could also be considered. In rare cases a wrist arthroscopy may be considered. (C) 2000 Elsevier Science Ltd. All rights re served.