Advertisement

European Journal of Nuclear Medicine

, Volume 19, Issue 10, pp 848–852 | Cite as

The reliability of the 3-phase bone scan in suspected scaphoid fracture: an inter- and intraobserver variability analysis

  • Monique M. C. Tiel-van Buul
  • Edwin J. R. van Beek
  • Annemarie van Dongen
  • Eric A. van Royen
Original Articles

Abstract

In the diagnosis of scaphoid fracture, the dynamic phase of the radionuclide bone scan alone has been recommended as an early test. To evaluate the independent reliability of the dynamic and static phases of the 3-phase bone scan in this diagnosis, 3 examiners reviewed the 3-phase bone scans of a series of 60 patients with clinical signs of fracture of the carpal scaphoid and with negative or non-diagnostic initial radiographs. The interpretation was performed independently and without the benefit of additional data. The bone scans were reviewed after 1 year by the same observers. The results were analyzed using kappa statistics. The bone scan was suspicious of fracture of the scaphoid in 15 patients. Irrespective of training and experience, the kappa values of the dynamic bone scan between any 2 observers did not exceed 0.57. The kappa values increased significantly when the static phase of the bone scan was examined (> 0.81). The intraobserver variability showed a similar pattern. We conclude that in suspected scaphoid fracture, the dynamic phase of the radionuclide bone scan alone cannot be used as a reliable diagnostic approach because of the low inter- and intraobserver agreement in the interpretation, irrespective of the experience and training of the observer.

Key words

Radionuclide scintigraphy Scaphoid fracture Bone scan Interobserver variability Intraobserver variability Kappa statistics 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Brismar J (1988) Skeletal scintigraphy of the wrist in suggested scaphoid fracture. Acta Radiol 29:101–107Google Scholar
  2. Duncan DS, Thurston AJ (1985) Clinical fracture of the carpal scaphoid — an illusionary diagnosis. J Hand Surg [Br] 10:375–377Google Scholar
  3. Ganel A, Engel J, Oster Z, Farine I (1979) Bone scanning in the assessment of fractures of the scaphoid. J Hand Surg [Br] 4:540–543Google Scholar
  4. Hawkes DJ, Robinson L, Crossman JE, Sayman HB, Mistry R, Maisey N, Spencer JD (1991) Registration and display of the combined bone scan and radiograph in the diagnosis and management of wrist injuries. Eur J Nucl Med 18:752–756Google Scholar
  5. Jørgensen TM, Andresen JH, Thommesen P, Hansen HH (1979) Scanning and radiology of the carpal scaphoid bone. Acta Orthop Scand 50:663–665Google Scholar
  6. London PS (1961) The broken scaphoid — a case against pessimism. J Bone Joint Surg [Br] 43:237–244Google Scholar
  7. Matin P (1979) The appearance of bone scans following fractures, including immediate and long-term studies. J Nucl Med 20:1227–1231Google Scholar
  8. Pendergrass HP, Potsaid MS, Castronovo FP (1973) The clinical use of 99mTc-diphosphonate. Radiology 107:557–562Google Scholar
  9. Rolfe EB, Garvie NW, Kahn MA, Ackery DM (1981) Isotope bone imaging in suspected scaphoid trauma. Br J Radiol 54:762–767Google Scholar
  10. Schmidt CH, Deininger HK (1985) Die maskierte Fraktur im Röntgenbild und ihr Nachweis durch die Skelettszintigraphie. Radiologie 25:104–107Google Scholar
  11. Southcott R, Rosman MA (1977) Non-union of carpal scaphoid fractures in children. J Bone Joint Surg [Br] 59:20–23Google Scholar
  12. Spitz J, Clemenz N (1986) Single phase bone scan in assessment of traumatic lesions? Eur J Nucl Med 4:A36Google Scholar
  13. Stewart MJ (1954) Fractures of the carpal navicular (scaphoid): a report of 435 cases. J Bone Joint Surg [Am] 36:998–1006Google Scholar
  14. Stordahl A, Schjøth A, Woxholt G, Fjermeros H (1984) Bone scanning of fractures of the scaphoid. J Hand Surg [Br] 9:189–191Google Scholar
  15. Sy WM, Bay R, Camera A (1977) Hand images: normal and abnormal. J Nucl Med 18:419–424Google Scholar
  16. Tiel-Van Buul MMC, Beek EJR van, Broekhuizen AH, Nooitgedacht EA, Davids PHP, Bakker AJ (1992) Diagnosing scaphoid fractures: radiographs cannot be used as a gold standard. Injury 23:77–79Google Scholar
  17. Verdan C (1960) Fractures of the scaphoid. Surg Clin North Am 40:461–464Google Scholar
  18. Verdan C, Narakos A (1986) Fractures and pseudo-arthrosis of the scaphoid. Surg Clin North Am 48:1083–1095Google Scholar
  19. Watson Jones R (1976) Fractures and joint injuries, 5 edn. Churchill Livingstone, EdiburghGoogle Scholar
  20. Weber ER, Chao EY (1978) An experimental approach to the mechanism of scaphoid wrist fractures. J Hand Surg [Br] 3:142–148Google Scholar
  21. Young MRA, Lowry JH, Laird JD, Ferguson WR (1988) 99mTc-MDP bone scanning of injuries of the carpal scaphoid. Injury 19:14–17Google Scholar

Copyright information

© Springer-Verlag 1992

Authors and Affiliations

  • Monique M. C. Tiel-van Buul
    • 1
  • Edwin J. R. van Beek
    • 2
  • Annemarie van Dongen
    • 1
  • Eric A. van Royen
    • 1
  1. 1.Departments of Nuclear MedicineAcademic Medical Centre, University of AmsterdamAmsterdamNetherlands
  2. 2.TraumatologyAcademic Medical Centre, University of AmsterdamAmsterdamNetherlands

Personalised recommendations