Original Article 495 Vol. 18, No. 6, 2004 Annals of Nuclear Medicine Vol. 18, No. 6, 495–499, 2004 ORIGINAL ARTICLE INTRODUCTION SCAPHOID FRACTURES are among the most common frac- tures of the wrist after fractures of the distal radius 1 and constitute 50–90% of fractures of the carpal bones. 2,3 Missed diagnosis and inadequate treatment of a scaphoid fracture frequently leads to nonunion and may cause pain and serious disability. With prompt diagnosis and subse- quent treatment, bony union will be obtained in 94%– 98.5% of such fractures. 4 Tenderness in the anatomical snuffbox is the classical sign of scaphoid fractures. However physical examina- tion findings are not specific and may be seen in patients without any fractures or with fractures of the radial sty- loid, trapezium and metacarpal bones. 2 In 35 to 75% of the cases scaphoid fractures are invisible on initial radio- graphs 5,6 and as a consequence patients are overtreated in order to avoid missing a scaphoid fracture. Patients can spend many weeks in cast unnecessarily. Bone scintigraphy has been used as a diagnostic tool complementary to radiographic examination in patients with suspected scaphoid fracture. 5,7–13 It may be used to confirm or exclude the diagnosis of a fracture in patients with negative initial radiographs. In this study we aimed to evaluate the role of bone scintigraphy using techne- tium-99m-hydroxymethylene diphosphonate (Tc-99m- MDP) in patients with suspected carpal fracture and normal or suspicious radiographs following carpal injury. MATERIALS AND METHODS Patients A prospective study was performed on patients with carpal trauma, showing clinical signs of scaphoid injury, ç ç Value of bone scintigraphy in patients with carpal trauma ・ ・ ・ ˆ Ümit Ö. AKDEMIR,* Tamer ATASEVER,* Serkan SIPAHIOGLU,** Seyda TÜRKÖLMEZ,* ˆ ˆ Cemal KAZIMOGLU** and Ertugrul SENER** *Department of Nuclear Medicine, Gazi University Medical Faculty, Ankara, Turkey **Department of Orthopedics, Gazi University Medical Faculty, Ankara, Turkey Objective: We planned this study to evaluate the role of bone scintigraphy in patients with suspected carpal fracture and normal or suspicious radiographs following carpal injury. Methods: Three- phase bone scintigraphy using Tc-99m-MDP was performed on 32 patients with negative radio- graphs but clinically suspected fracture at two weeks after the trauma. Focally increased radiophar- maceutical uptake was interpreted as a fracture. The final diagnosis was established with clinical follow-up. Results: Twelve (38%) patients had a normal scan excluding fracture. Twelve patients had a single fracture. Multifocal fracture was present in 8 (25%) patients. Eight patients showed scaphoid fractures; of these three showed single scaphoid fracture, and the other five patients revealed accompanying fractures. Distal radius fractures and carpal bone fractures other than scaphoid were both observed in 12 patients. These were eleven fractures of distal radius; three fractures of pisiform; two fractures of hamate; and single fractures of lunate, trapezium and triquetrum. In one patient there was fracture of a first metacarpal bone. Conclusion: In patients with suspected carpal bone fracture and normal or suspicious radiographs, bone scintigraphy can be used as a reliable method to confirm or exclude the presence of a scaphoid fracture and to detect clinically unsuspected fractures of distal radius and other carpal bones. Key words: bone scintigraphy, carpal trauma, fracture ç Received December 6, 2003, revision accepted May 17, 2004. For reprint contact: Ümit Ö. Akdemir, M.D., Gazi Üniversitesi Tıp Fakültesi, Nükleer Tıp AD, Besevler/Ankara, P.K. 06500, TURKEY. E-mail: o_akdemir@yahoo.com