Original Article

Langenbeck's Archives of Surgery

, Volume 386, Issue 2, pp 150-154

Diagnosis of occult scaphoid fractures and other wrist injuries

Are repeated clinical examinations and plain radiographs still state of the art?
  • Christian GäblerAffiliated withDepartment of Traumatology, University of Vienna Medical School, AKH – Waehringer Guertel 18-20, 1090 Vienna, Austria
  • , Chris KuklaAffiliated withDepartment of Traumatology, University of Vienna Medical School, AKH – Waehringer Guertel 18-20, 1090 Vienna, Austria
  • , Martin J. BreitenseherAffiliated withOsteology and MRI Institute of the Department of Radiology, University of Vienna Medical School, AKH – Waehringer Guertel 18-20, 1090 Vienna, Austria
  • , Siegfried TrattnigAffiliated withOsteology and MRI Institute of the Department of Radiology, University of Vienna Medical School, AKH – Waehringer Guertel 18-20, 1090 Vienna, Austria
  • , Vilmos VécseiAffiliated withDepartment of Traumatology, University of Vienna Medical School, AKH – Waehringer Guertel 18-20, 1090 Vienna, Austria

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Abstract.

To examine the efficacy of repeated clinical examinations and follow-up radiographs, 121 patients were prospectively and consecutively randomised and clinically followed until a final diagnosis was achieved. All of these patients additionally underwent magnetic resonance imaging (MRI) scans within an 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 injuries were scaphoid fractures. There were 15 fractures of other carpal bones, 14 avulsion fractures of extrinsic ligaments (AFL), 26 other bone injuries (fractures of distal radius, fractures of radial styloid, ulnar head fracture metacarpal fracture, bone bruises), and 29 soft tissue injuries (triangular fibro-cartilaginous complex injuries, complete or partial ruptures of the scapholunate ligament, ruptures of the radial collateral ligament, hemarthrosis). By means of repeated clinical examinations and plain scaphoid 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 AFLs 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 clinical and radiological standard procedures are reliable in the diagnosis of occult fractures of the carpus and wrist when performed by experienced observers. MRI scans are indicated for early diagnosis of occult fractures and soft tissue injuries about the wrist.

Occult scaphoid fractures Diagnosis MRI