Panoramic versus conventional radiography of scaphoid fractures

OBJECTIVE. The objective of this study was to compare the diagnostic value of panoramic and conventional radiography in the detection of fractures of the carpal scaphoid bone. MATERIALS AND METHODS. Panoramic (orthopantomographic) and conventional radiographs of 90 patients with acute or chronic wrist trauma were reviewed retrospectively. Images were analyzed and reviewed independently by four observers: two radiologists and two traumatologists. The kappa statistic was used to calculate intra- and interobserver agreement and the correlation between the two imaging techniques. RESULTS. Panoramic radiography of the wrist was superior to conventional radiography in ruling out scaphoid fractures (74%, 20/27) in patients with suspicious findings on conventional radiography; revealed more cases of scaphoid fractures (21.4%, 12/56); and revealed more cases of delayed union (n = 2), nonunion (n = 3), and union (n = 3). Agreement values were higher, with better inter- and intraobserver agreement, for the panoramic examinations than for the conventional radiographic examinations. CONCLUSION. The panoramic examination of the wrist is a useful technique for the diagnosis and follow-up of scaphoid fractures. Its use is recommended as a complement to conventional radiography in cases with inconclusive findings.