Radiographic assessment of soft tissue signs in clinically suspected scaphoid fractures: the incidence of false negative and false positive results.

Radiographs of 127 patients who presented with suspected scaphoid fractures were reviewed to determine whether, as recent studies have suggested, an absence of dorsal soft tissue swelling of the wrist and a normal scaphoid fat stripe invariably excluded the possibility of such a fracture. Both false negative and false positive results were found to occur. False negative results (only approximately one in four patients with normal soft tissue signs had scaphoid fractures) might occur if the radiograph was obtained before the onset of edema. False positive results (only approximately a third of patients with abnormal soft tissue signs did not have any bony injury) might reflect soft tissue injury alone. Normal soft tissue signs do not exclude the possibility of a scaphoid fracture. Abnormal signs do not always indicate a scaphoid fracture.