Imaging the scaphoid problem : a diagnostic strategy for suspected scaphoid fractures

Abstract

In this thesis, the diagnostic value of bone scintigraphy in daily practice has been assessed. In addition, the results of bone scintigraphy have been compared with clinical outcome and the observer variation of bone scintigraphy has been established. Furthermore, the role of acute MR imaging in suspected scaphoid fractures and the observer variation of MR imaging have been determined. Finally, the function of the wrist and strength measurements have been assessed for their use in the diagnostic strategy of suspected scaphoid fractures The following conclusions have been established. Firstly, suspected scaphoid fractures are common and mandate further investigation. Secondly, function of the wrist and strength measurements improve the diagnostic strategy of suspected scaphoid fractures. Thirdly, MR imaging fails to identify up to 20% of scaphoid fractures. Fourthly, the observer variation of bone scintigraphy is less than the observer variation of MR imaging. Finally, bone scintigraphy in combination with clinical follow-up is the standard for suspected scaphoid fractures to date.