Isotope bone imaging in suspected scaphoid trauma

Abstract

The unreliability of radiological examination in excluding or confirming a suspected scaphoid fracture after carpal trauma is a well-recognised diagnostic problem. This paper explores the role of isotope bone imaging (IBI) in the early identification of carpal bone injury. Abnormal generalized uptake of activity may be seen within the carpus, possibly as a consequence of diffuse soft tissue injury, particularly if imaging is performed within 48 hours of trauma. A focal area of increased uptake related to one carpal bone is suggestive of fracture though the part which ligamentous injury, localized periosteal reaction or incomplete cortical infarction may play in the production of such radionuclide appearances is uncertain. Ninety-nine patients with suspected recent scaphoid fracture but no demonstrable abnormality on radiological examination were subjected to IBI, using 555 MBq (15 mCi) of 99Tcm methylene diphosphonate. Abnormal focal increased uptake (AFIU) was found in 47 patients, this being localized to the scaphoid bone in 26. Of these 47 cases, 19 (42%) showed subsequent radiological evidence of fracture. The results of IBI, in our experience, can only be reliably interpreted if imaging is performed at least 48 hours after injury, though in cases of fracture AFIU may persist for several years. Using this technique, the possibility of fracture can be confidently excluded in that group of patients who show no AFIU. In selected cases of carpal trauma, IBI provides a satisfactory alternative means of identifying the presence and site of localized injury within the carpus and may be used to confidently exclude those patients with non-osseous symptomatology.