The use of three-phase bone scintigraphy in the diagnosis of the radiographically occult scaphoid fracture

Abstract

Diagnosis of a scaphoid fracture represents a diagnostic challenge to the physician. It used to be thought that if a scaphoid fracture was present but could not be confirmed on radiographs at the time of injury, it would show up on radiographs around 10 to 14 days afterwards and only required placing the patient's wrist in a plaster cast until that time. This theory is still taught to students today, but the fact of the matter is that it has been known since 1981 that only an additional 2% of scaphoid fractures are demonstrated at this time and it may be up to six weeks before a scaphoid fracture can be safely excluded by radiographs. An early diagnosis of scaphoid fractures is crucial to initiate adequate treatment in order to avoid complications such as delayed healing, nonunion, pseudoarthosis, avascular necrosis, and arthrosis of the wrist. It is estimated that nonunion occurs in 5- 12% when prompt and adequate treatment is given. This rises as high as 88% when scaphoid fractures are not recognised within four weeks. So, early effective diagnosis is of the utmost importance in such cases. The role of bone scintigraphy has been well established for a number of years in the field of orthopaedics and used on a routine basis abroad for such cases. Surprisingly, bone scintigraphy is still limited locally to the diagnosis of osteomyelitis, Paget's disease, and malignant bone disorders, so the researcher decided to challenge the traditional way of diagnosing a scaphoid fracture and investigate the role of threephase bone scintigraphy in occult fracture detection.