SCIENTIFIC IMPORTANCE OF X-RAYS—GARLAND 191 
The detection of a gross fracture in an ordinary roentgenogram 
_ is a simple matter; the detection of fine or fissure fractures is often 
extremely difficult. An important example of this is in injuries in- 
volving the wrist, probably the most commonly injured area in the 
body (see pl. 2, fig.1). One type of “sprain injury” results in fracture 
of the scaphoid or navicular bone, a small bone in the wrist joint. 
This bone has a very critical blood supply. If injured, healing re- 
quires immediate and complete immobilization for many weeks. Frac- 
tures of this bone are often difficult to detect except in films of the 
highest technical quality; three or four views may be necessary be- 
fore the crack can be confirmed or excluded. If overlooked, and the 
wrist is not immobilized, most of these cases result in nonunion and 
chronic arthritis in the wrist joint, a serious source of disablement 
in laborers. Attempts have been made to restore the function of the 
joint by removing the two broken pieces of scaphoid and replacing 
them with a synthetic bone (made of a biologically tolerable metal 
such as vitallium) but these results have not been conspicuously suc- 
cessful. The only method of assuring safety is early X-ray diagnosis 
and complete immobilization. 
Fractures of the ribs are quite common and usually unimportant 
injuries and the vast majority of them heal without any particular 
treatment. However, compensation and legal considerations often 
require an answer as to whether or not a fracture is present in a 
given case of alleged chest injury. In at least 10 percent of actual 
fracture cases, the fracture line is not immediately demonstrable by 
ordinary X-ray methods. It is concealed by its obliquity or by over- 
lapping parts. Therefore, your physician may tell you in such a 
case that there is “no X-ray evidence of fracture” rather than “there 
is no fracture.” If it should be of legal importance to confirm a 
suspected fracture in such a case, reexamination at the end of 4 weeks’ 
time usually will provide the answer. By that time a little “fuzz” 
of new bone will be present in the fracture site and will be visible 
in the roentgenograms. 
Roentgen methods are also invaluable in the detection of various 
types of bone disease due to infection, tumor, and so forth. However, 
the shadows cast often are not characteristic of one particular infec- 
tion. For example, a bone that has been disused for several weeks 
(perhaps in the foot, when a patient is wearing an extensive plaster 
splint for fracture of the upper leg) may cast a shadow identical with 
that of one extensively diseased. Therefore, it is necessary for the 
roentgenologist to have some of the clinical facts or history of a given 
case before rendering an interpretation of a film. The film is not 
misleading; our deductions, in the absence of clinical data, may be 
misleading. 
