Computed tomography for triage of suspected scaphoid fractures

The use of computed tomography (CT) to triage suspected scaphoid fractures is appealing because it is more readily available and less expensive than magnetic resonance imaging (MRI). Twenty-eight patients with suspected scaphoid fractures (defined as tenderness in the area of the scaphoid and initial scaphoid-specific radiographs interpreted as normal) were enrolled in a prospective protocol evaluating triage with CT. Twenty patients reached an endpoint consisting of either (1) identification of a fracture accounting for the patient's symptoms on CT or (2) normal radiographs 6 weeks or more from the time of injury. Only 2 of 28 patients (7%) were diagnosed with a nondisplaced fracture of the scaphoid waist. CT revealed an avulsion fracture of the distal pole of the scaphoid in two patients, nondisplaced fractures of the distal radius in six patients, and nondisplaced fractures of other carpal bones in four patients. Radiographs of the scaphoid taken 6 weeks or greater from the time of injury were interpreted as normal in the six patients with normal CT scans that completed the study. True scaphoid waist fractures are uncommon among patients with suspected scaphoid fractures. CT scans are useful for triage of suspected scaphoid waist fractures because alternative, less-troublesome fractures were identified in 43% of patients and no fractures were missed or undertreated. Immediate triage of suspected scaphoid fractures using CT in the emergency room has the potential to reduce unnecessary immobilization and diminish overall costs associated with treatment.