Authors: Nguyen, Q.; Chaudhry, S.; Sloan, R.; Bhoora, I.; Willard, C.

Source: Annals of The Royal College of Surgeons of England, Volume 90, Number 6, September 2008 , pp. 488-491(4)

Publisher: The Royal College of Surgeons of England

Abstract:

INTRODUCTION: Up to 40% of scaphoid fractures are missed at initial presentation as clinical examination and plain radiographs are poor at identifying scaphoid fractures immediately after the injury. Avoiding a delay in diagnosis is essential to prevent the risk of non-union and early wrist arthritis. We demonstrate the use of CT scanning for the early confirmation of a scaphoid fracture.

PATIENTS AND METHODS: We conducted a retrospective, chronological review of patients who attended an upper limb fracture clinic from January 2001 to October 2003 in a small district general hospital. We performed a CT scan on all 'clinical scaphoid' patients who had negative plain X-ray films.

RESULTS: Overall, 70% of patients had a CT scan within 1 week of injury and not from date of accident and emergency attendance; 83% of patients had a CT scan within 2 weeks of injury. Of 118 patients identified, 32% had positive findings and 22% of 'clinical scaphoid' patients had scaphoid fractures. The proportion of positive findings for an acute scaphoid fracture was 68%. Additional pathologies identified on CT were capitate, triquetral and radial fractures.

CONCLUSIONS: Our audit shows that it is practical to perform CT on suspicious scaphoid fractures in a small district general hospital. We identified an extremely high false-negative rate for plain X-rays and demonstrate that the appropriate use of CT at initial fracture clinic attendance with 'clinical scaphoid' leads to an earlier diagnosis and reduces the need for prolonged immobilisation and repeated clinical review.

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Keywords: SCAPHOID FRACTURE; COMPUTED TOMOGRAPHY; FRACTURE CLINIC

Document Type: Research article

DOI: http://dx.doi.org/10.1308/003588408X300948

Affiliations: 1: Department of Trauma and Orthopaedics, Stafford Hospital, Stafford, UK

Publication date: 2008-09-01

More about this publication?

• The Annals of The Royal College of Surgeons of England is the official journal of the College and is published eight times a year in January, March, April, May, July, September, October and November. The main aim of the journal is to publish high quality, peer-reviewed papers that relate to all branches of surgery.
  
  The Annals also includes letters and comments, a regular technical section, NICE news, controversial topics, CORESS feedback, book reviews and the best trainee presentations from England and Wales. The editorial board is composed of members of the College Council and experts from across the surgical specialties.
  
  Archive issues of the Annals of The Royal College of Surgeons of England are available via the PubMed Central database
  
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