Abstract
Purpose Fractures of the proximal pole of the scaphoid are prone to adverse outcomes such
as nonunion and avascular necrosis. Distinction of scaphoid proximal pole fractures
from waist fractures is important for management but it is unclear if the distinction
is reliable.
Methods A consecutive series of 29 scaphoid fractures from one tertiary hospital was collected
consisting of 5 scaphoid proximal pole and 24 scaphoid waist fractures. Fifty-seven
members of the Science of Variation Group (SOVG) were randomized to diagnose fracture
location and displacement by using radiographs alone or radiographs and a computed
tomography (CT) scan.
Results Observers reviewing radiographs alone and observers reviewing radiographs and CT
scans both had substantial agreement on fracture location (κ = 0.82 and κ = 0.80,
respectively; p = 0.54). Both groups had only fair agreement on fracture displacement (κ = 0.28 and
κ = 0.35, respectively; p = 0.029).
Conclusion Proximal pole fractures are sufficiently distinct from proximal waist fractures that
CT does not improve reliability of diagnosis.
Level of Evidence Level IV interobserver reliability case-control study.
Keywords
scaphoid fracture - radiograph - CT scan - interobserver study
