The Journal of hand surgery, European volume
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In a prospective study we performed bone scans on 84 patients who had sustained a wrist injury and in whom a scaphoid fracture was clinically suspected but could not be confirmed on the original set of five routine "scaphoid view" radiographs. In 40 patients the bone scan was normal and in 25 there was increased uptake in areas other than the scaphoid. ⋯ In seven of these a scaphoid fracture was subsequently demonstrated on repeat radiographs (five cases) or a CT scan (two cases). In the remaining 12 no fracture could be demonstrated.
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It has been suggested that a positive scaphoid compression test will reliably confirm the presence of a fractured scaphoid in those patients presenting with an injury clinically suggestive of this, but without a fracture visible on initial X-rays. A prospective study was carried out in 99 patients presenting with an injury clinically suggestive of a scaphoid fracture. 74 patients had positive scaphoid compression tests with 24 of these patients having a scaphoid fracture visible on initial X-ray and seven having a fracture diagnosed either by repeat X-ray or bone scan 2 weeks after injury. 25 patients had a negative test, with ten having a scaphoid fracture visible on initial X-ray and three on repeat X-ray at 2 weeks. These results show that this test had a sensitivity of 70.5%, a specificity of 21.8% and predictive value of 41.9%. A positive scaphoid compression test is an unreliable diagnostic aid for a scaphoid fracture.