Diagnosis of occult scaphoid fractures and other wrist injuries - Are repeated clinical examinations and plain radiographs still state of the art?

To examine the efficacy of repeated clinical examinations and follow-up rad iographs, 121 patients were prospectively and consecutively randomised and clinically followed until a final diagnosis was achieved, All of these pati ents additionally underwent magnetic resonance imaging (MRI) scans within a n average of 3 days after trauma to control the results of this study. MRI detected 112 injuries in 82 patients (67%). Twenty-eight (25%) of these inj uries were scaphoid fractures, There were 15 fractures of ether carpal bone s, 14 avulsion fractures of extrinsic ligaments (AFL), 26 other bone injuri es (fractures of distal radius. fractures of radial styrloid, ulnar head fr acture metacarpal fracture, bone bruises), and 29 soft tissue injuries (tri angular fibro-cartilaginous complex injuries, complete or partial ruptures of the scapholunate: ligament, ruptures of the radial collateral ligament, hemarthrosis). By means of repented clinical examinations and plain scaphoi d views, experienced observers were able to detect all the occult scaphoid fractures within 38 days. as well as most of the other fractures about the wrist except one fracture of the triquetrum. Soft tissue injuries, however, were diagnosed only in two cases of complete scapholunate ligament tears, It was further obvious that 70% of all scaphoid fractures and 60% of the AF Ls were detected in a review of the initial X-rays by experienced surgeons. Only 30% of all scaphoid fractures detected were really occult and all of these were diagnosed correctly. This prospective study demonstrates that cl inical and radiological cal standard procedures are reliable in the diagnos is of occult fractures of the carpus and wrist when performed by experience d observers. MRI scans are indicated for early diagnosis of occult fracture s and soft tissue injuries about the wrist.