Accuracy of the radiological protocols in detecting scaphoid fractures, a retrospective study

Early and accurate diagnosis of scaphoid fractures is vital for improving patient outcomes. However, there is no international agreement on the optimal imaging examination for diagnosing suspected scaphoid fractures. This study aimed to assess the different imaging examinations of scaphoid fractures at three major hospitals in Najran, Saudi Arabia. Radiological strategies for imaging suspected scaphoid fracture were determined using a short cross-sectional survey. The accuracy of the different imaging techniques was compared, and the number of patients with a scaphoid fracture who underwent examination at these hospitals in the past year preceding the start of this study was also investigated. The results showed that plain x-ray was the first line of imaging examination for suspected scaphoid fracture at the three hospitals. When the initial plain x-ray could not rule out scaphoid fracture, a repeated x-ray (10-14 days) was used as second-line imaging in two hospitals, while computed tomography (CT) was used as a third line of imaging. In the third hospital, CT scan was used as the second line of imaging, while magnetic resonance imaging (MRI) was used as the third line of imaging. A total of 112 patients sustained scaphoid fractures in the three hospitals. Initial plain x-ray was able to diagnose 72% of all cases as the first imaging line. Repeated x-ray identified 60% of the fractures that were not detected on the initial plain radiograph, while CT scans identified 88% of the fractures that were not detected on the first plain radiograph. Repeated plain x-rays maybe not be the ideal second-line imaging for scaphoid fracture. The ability of the CT scan to detect scaphoid fracture at an early stage was evident (p = 0.001). Altogether, these results indicate the important role of CT scan in diagnosing scaphoid fracture at an early stage. More studies are warranted to improve the national guidelines for the radiological investigation of scaphoid fractures.