Diagnostic modalities for the occult scaphoid fracture

Abstract

The aim of this thesis is

to add new data and to review the current literature for the most appropriate

diagnostic modality for detecting a scaphoid fracture that is not visible on

conventional radiography (occult fracture). We found that specificity of MRI is lower than reported in literature and this has implications for all studies using MRI as a reference standard. CT may be a very practical diagnostic modality in the diagnostic workup for patients with a suspected scaphoid fractures. The fractures missed with CT and the moderate observer agreement are a problem. However, missed fractures with CT are possibly the fractures that have a very good prognosis.The radiation exposure of CT is low, especially when the scan is made without a plaster cast. For the diagnosis of the occult scaphoid fracture, MRI and bone scintigraphy can be used as well, however they also have limitations. Literature is not very consistent in results of MRI and sensitivity and specificity may be overestimated due to publication bias, no true reference standard and low prevalence of true fractures. Bone scintigraphy lacks specificity, however combined with CT (SPECT/CT) it could be the most reliable method.