Outcome of follow-up computed tomography of suspected occult scaphoid fracture after normal radiography.

Purpose: To evaluate the rate of missed scaphoid fractures on follow-up computed tomography (CT) for suspected occult scaphoid fracture after normal radiography with residual radial-sided wrist pain.

Methods: In a retrospective analysis, wrist CT during a five-year period was analyzed. The CT examinations and radiological reports were re-evaluated. Available clinical findings and radiologic follow-up performed during a period of a minimum of three years served as outcome reference.

Results: In total, 178 examinations had been performed on 174 patients for suspect scaphoid fracture, 67 men and 107 women, showing 15 and 6 scaphoid fractures, respectively; a statistically significant sex difference (p = 0.0024). In 157 examinations, no scaphoid fracture was detected on CT, instead 29 other wrist or carpal bone fractures were found. On follow-up, no missed scaphoid fractures were found. Before CT, 124 of the 157 patients had been treated with a cast. After CT, 35 patients continued with cast treatment for a median of 14 days.

Conclusions: CT appears to be a reliable method for evaluating suspect scaphoid fracture as part of a diagnosis-treatment regimen including pain immobilization with a plaster cast.