Fracture of the carpal navicular--efficacy of clinical findings and improved diagnosis with six-view radiography.

A prospective study was conducted to determine the usefulness of clinical findings and 25-degree pronation and supination radiologic views to diagnose carpal navicular fractures. All patients presenting to the emergency department during a two-year period who fell on their outstretched hand and had pain and/or swelling in the anatomic snuffbox were evaluated initially and at two weeks. All patients received at least the standard four-view wrist radiography. If a fracture was not detected, two additional views were obtained. Ninety patients were enrolled; 54 fractures of the navicular were evident on initial four-view radiography. Thirty-six patients with a negative initial four-view radiograph had two additional views; 11 of the 36 were found to have a fracture. The other 25 patients failed to show fracture. In this series; no fractures were missed when six-view radiography was used. Anatomic snuffbox tenderness was 100% sensitive and 76% specific and had a 92% positive predictive value for carpal navicular fracture. We conclude that patients clinically suspected of carpal navicular fracture should undergo additional radiologic views if the standard four views of the wrist are negative.