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Diagnosis of scaphoid fracture: optimal imaging techniques

Authors Geijer M

Received 23 May 2013

Accepted for publication 1 July 2013

Published 31 July 2013 Volume 2013:6 Pages 57—69


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

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Mats Geijer

Center for Medical Imaging and Physiology, Skåne University Hospital and Lund University, Lund, Sweden

Abstract: This review aims to provide an overview of modern imaging techniques for evaluation of scaphoid fracture, with emphasis on occult fractures and an outlook on the possible evolution of imaging; it also gives an overview of the pathologic and anatomic basis for selection of techniques. Displaced scaphoid fractures detected by wrist radiography, with or without special scaphoid views, pose no diagnostic problems. After wrist trauma with clinically suspected scaphoid fracture and normal scaphoid radiography, most patients will have no clinically important fracture. Between 5% and 19% of patients (on average 16% in meta-analyses) will, however, have an occult scaphoid fracture which, untreated, may lead to later, potentially devastating, complications. Follow-up imaging may be done with repeat radiography, tomosynthesis, computed tomography, magnetic resonance imaging (MRI), or bone scintigraphy. However, no method is perfect, and choice of imaging may be based on availability, cost, perceived accuracy, or personal preference. Generally, MRI and bone scintigraphy are regarded as the most sensitive modalities, but both are flawed by false positive results at various rates.

Keywords: occult fracture, wrist, radiography, computed tomography, magnetic resonance imaging, radionuclide imaging

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