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CT Wrist / Scaphoid

CTNo contrastMSK
Indications
  • Suspected scaphoid fracture with negative radiographs (or characterization of a known fracture)
  • Scaphoid union assessment after cast or fixation
  • Carpal fracture/dislocation; distal radius intra-articular fracture
  • Hardware assessment
Patient prep
  • Remove watch/jewelry; splint off if safely possible (or keep if radiolucent)
  • Prone with the arm extended overhead ('superman') when tolerated — centers the wrist and takes the torso out of the beam
  • No contrast
Contrast
None / non-contrast
Technique
  • Ultra-thin acquisition (≤0.6 mm collimation), small DFOV ~10 cm (do not go below 10 cm), bone algorithm
  • Standard axial/coronal/sagittal sets PLUS dedicated oblique reformats along the scaphoid long axis (oblique-sagittal and oblique-coronal) — the money view for fracture line and union
  • Metal artifact reduction recon when a headless screw is present for union assessment
  • Low dose — a small extremity away from the torso needs very little
Series / Sequences
#Series / SequencePlaneThicknessNotes
1Axial boneaxial0.5-0.6 mmBone kernel
2Coronal/sagittal reformatcoronal0.5-1 mmStandard carpal survey
3Scaphoid-axis oblique reformatsoblique0.5-1 mmAlong scaphoid long axis; fracture, humpback deformity, bridging bone
43D VR (selective)3DVRComplex carpal dislocation
Key points
  • Reformats along the scaphoid's own long axis — not the wrist's — are what make subtle fractures and partial union visible
  • CT quantifies displacement, angulation (humpback deformity) and percentage of bridging trabeculae for union
  • MRI is more sensitive for a truly radiographically occult fracture (bone marrow edema); CT answers the anatomy/union questions
  • For DRUJ instability see the dedicated dynamic pronation/supination protocol
References
• ACR Appropriateness Criteria: Acute Hand and Wrist Trauma link
• Radiology: Wrist Fractures — What the Clinician Wants to Know (Goldfarb et al., 2001) link
• Radiopaedia: Scaphoid fracture link
Source: Researched — verify against your institution
‹ PreviousCT Wrist — DRUJ Instability (Dynamic Pronation/Supination)
Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.