Scaphoid fractures: Evaluation with high-spatial-resolution US - Initial results

PURPOSE: To evaluate the diagnostic accuracy of high-spatial-resolution ult rasonography (US) in the diagnosis of scaphoid fractures. MATERIALS AND METHODS: In 72 hours after acute wrist trauma, 15 consecutive patients were examined for possible scaphoid fractures clinically:and With conventional radiographs, including scaphoid views. Thereafter, high-spati al-resolution US was performed by two experienced radiologists blinded to t he results of the previously performed investigations. High-spatial-resolut ion US of the scaphoid bones was performed from the palmar, lateral, and do rsal directions in the longitudinal and transverse planes. US findings indi cative of a: scaphoid fracture were cortical discontinuity and/or periostea l elevation. Finally, magnetic resonance (MR) images (short inversion time inversion-recovery, T1- and T2*-weighted) (ie, the standard) of the affecte d wrist were obtained and evaluated for a possible scaphoid fracture by two radiologists in consensus. RESULTS: Nine of 15 patients had scaphoid fractures. Seven (78%) of nine pa tients had positive findings at high-spatial-resolution US and five (56%) h ad such findings at conventional radiography (ie, four occult scaphoid frac tures), with an accuracy Of 87% and 73%, respectively. Two (50%) of four ra diographically occult scaphoid fractures were depicted with high-spatial-re solution US. Sonographic findings of scaphoid fractures were either cortica l discontinuity (n = 4), periosteal elevation (n = 2), or a combination of these two findings (n = 1). CONCLUSION: High-spatial-resolution US is a reliable diagnostic tool for th e evaluation of occult scaphoid fractures and should be considered an adequ ate alternative diagnostic tool prior to computed tomography or MR imaging.