A comparative analysis of the accuracy, diagnostic uncertainty and cost of imaging modalities in suspected scaphoid fractures.

Abstract

Clinical examination of suspected scaphoid fractures is sensitive, but not specific, and initial plain radiographs lack sensitivity. A variety of second-line imaging techniques have been proposed to improve immediate diagnosis and reduce overtreatment. Different sample populations and methods of reporting test performance have made side-by-side comparison difficult. The aim of this study is to describe the epidemiology of clinically suspected scaphoid fracture and determine the prevalence of true fracture. These data are used to compare second-line imaging techniques in our population. 200 consecutive patients attending a trauma service with clinically suspected scaphoid fracture were followed through diagnosis to discharge. The prevalence of true fracture was 16% and was associated with male sex and injury playing sport. Magnetic resonance imaging has the best diagnostic performance, with the added benefit of soft tissue evaluation, but was the most expensive option. Ultrasound examination was least effective in detecting true fractures. Future studies should further evaluate the clinical and economic sequelae of overtreatment of suspected fractures. Clinicians should examine alternatives to "empirical" treatment without definite diagnosis based on their local facilities and patient demographics.