• Jaycen Cruickshank, Alex Meakin, Ross Breadmore, David Mitchell, Steven Pincus, Thomas Hughes, Bronwyn Bently, Mark Harris, and Austin Vo.
• Emergency Department, Ballarat Health Services, Ballarat, Victoria, Australia. jaycenc@bhs.org.au
• Emerg Med Australas. 2007 Jun 1;19(3):223-8.

ObjectiveTo validate the use of early CT in predicting scaphoid fracture and other fractures in patients with suspected scaphoid fracture.MethodA prospective observational study of adult patients with a diagnosis of clinical scaphoid fracture presenting to a regional ED. Patients were immobilized in a scaphoid plaster and had a CT (wrist and carpals) same or next day. The gold standard used was the diagnosis on Day 10 with clinical examination and X-rays, with MRI performed in patients with persistent tenderness but normal X-rays.ResultsForty-seven patients completed the study protocol from September 2004 until February 2006. For all fractures, early CT had a 96.8% negative predictive value and 100% positive predictive value (94.4% sensitive, 100% specific). No scaphoid fracture was missed by early CT. One patient had a trapezium fracture on CT, with a coexistent subtle capitate fracture only detected on MRI.ConclusionEarly CT scans show promise in the diagnosis of scaphoid and other fractures of the wrist and carpals. Further study is warranted to validate early CT in clinical scaphoid fracture as an alternative to other early advanced imaging, or plaster immobilization and 2 week review.

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