Improved Detection of Scaphoid Fractures with High-Resolution Peripheral Quantitative CT Compared with Conventional CT

• DOI: 10.2106/jbjs.20.00124
• Publication Date: 2020-10-29T01:00:20Z
• Authors: A.M. Daniels; M.S.A.M. Bevers; S. Sassen; C.E. Wyers; B. van Rietbergen; P.P.M.M. Geusens; S. Kaarsemaker; P.F.W. Hannemann; M. Poeze; J.P. van den Bergh; H.M.J. Janzing
• Keywords: RADIOGRAPHS; Adult; Male; Scaphoid Bone; WAIST; ACCURACY; 0206 medical engineering; COST; 02 engineering and technology; Middle Aged; DISTAL RADIUS; Sensitivity and Specificity; DIAGNOSTIC PERFORMANCE; BONE-SCINTIGRAPHY; 3. Good health; Fractures, Bone; POSTMENOPAUSAL WOMEN; DENSITY; Humans; COMPUTED-TOMOGRAPHY; Female; Tomography, X-Ray Computed; Aged

Background: Computed tomography (CT), magnetic resonance imaging, and bone scintigraphy are second-line imaging techniques that are frequently used for the evaluation of patients with a clinically suspected scaphoid fracture. However, as a result of varying diagnostic performance results, no true reference standard exists for scaphoid fracture diagnosis. We hypothesized that the use of high-resolution peripheral quantitative CT (HR-pQCT) in patients with a clinically suspected scaphoid fracture could improve scaphoid fracture detection compared with conventional CT in the clinical setting.

Methods: The present study included 91 consecutive patients (≥18 years of age) who presented to the emergency department with a clinically suspected scaphoid fracture between December 2017 and October 2018. All patients were clinically reassessed within 14 days after first presentation, followed by CT and HR-pQCT. If a scaphoid fracture was present, the fracture type was determined according to the Herbert classification system and correlation between CT and HR-pQCT was estimated with use of the Kendall W statistic or coefficient of concordance (W) (the closer to 1, the higher the correlation).

Results: The cohort included 45 men and 46 women with a median age of 52 years (interquartile range, 29 to 67 years). HR-pQCT revealed a scaphoid fracture in 24 patients (26%), whereas CT revealed a scaphoid fracture in 15 patients (16%). Patients with a scaphoid fracture were younger and more often male. The correlation between CT and HR-pQCT was high for scaphoid fracture type according to the Herbert classification system (W = 0.793; 95% confidence interval [CI], 0.57 to 0.91; p < 0.001) and very high for scaphoid fracture location (W = 0.955; 95%, CI 0.90 to 0.98; p < 0.001).

Conclusions: In the present study, the number of patients diagnosed with a scaphoid fracture was 60% higher when using HR-pQCT as compared with CT. These findings imply that a substantial proportion of fractures—in this study, more than one-third—will be missed by the current application of CT scanning in patients with a clinically suspected scaphoid fracture.

Level of Evidence: Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.