In the diagnosis and treatment of fractures of the carpal navicular more emphasis should be placed on the clinical signs and symptoms than on the roentgenographic findings. A negative initial roentgenographic examination does not necessarily rule out a fracture. Several variations from the usual technique have been employed when the ordinary posteroanterior view is negative for, or suspicious of, a fracture of this bone:
1. Exposures should be made with the hand in ulnar deviation.
2. Roentgenograms should also be taken with two exposures,-one with the tube shifted a little to the right, and the other with the tube shifted to the left.
If, despite negative roentgenograms, clinical signs and symptoms exist, the part should be adequately immobilized. Sometimes, several weeks or even months later, subsequent roentgenographic examination may reveal the fracture site brought to light by the process of osteoporosis.
(C) 1939 All Rights Reserved.The Journal of Bone and Joint Surgery, Inc.