Suspected scaphoid fractures. Can we avoid overkill?

Among 231 patients with clinical signs of a fractured carpal scaphoid but negative primary radiographs, only 3 fractures of the scaphoid were finally diagnosed on subsequent radiological and clinical examinations. Two of these could be seen retrospectively in the primary radiographs. After an observation period of two to three weeks in dorsal plaster casts, 88.8% of the patients were discharged from the outpatient department as having soft-tissue injuries. They required no further treatment. This "overkill" is unsatisfactory, as we agree with other studies that almost 100% of factual fractures of the scaphoid bone are visible on initial radiographs of good quality, using 4 or 5 different views and evaluated by a senior radiologist. We propose a more stringent clinical inclusion into the category of "clinical scaphoid fracture" and the use of simple supportive bandages in an observation period.