Diagnostic value of ultrasound in scaphoid fractures

Christiansen, T.; Rude, C.; Lauridsen, K.K.; Christensen, O. M.

doi:10.1016/0020-1383(91)90104-m

Cited by 36 publications

(16 citation statements)

References 10 publications

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“…It is also highly operator-dependent. Christiansen et al found a sensitivity of 47% and a specificity of 61% with this technique 28. They concluded that ultrasound is not suitable for the early diagnosis of scaphoid fracture.…”

Section: Discussionmentioning

confidence: 99%

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Role of MRI in the diagnosis of clinically suspected scaphoid fracture: analysis of 611 consecutive cases and literature review

Khalid

Jummani²,

Kanagaraj³

et al. 2010

Emergency Medicine Journal

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Section: Discussionmentioning

confidence: 99%

“…Intrasound vibration has been suggested as an alternative diagnostic modality for the diagnosis of occult scaphoid fractures 28 29. A sensitivity of 100% and specificity of 95% has been reported 29.…”

Section: Discussionmentioning

confidence: 99%

Role of MRI in the diagnosis of clinically suspected scaphoid fracture: analysis of 611 consecutive cases and literature review

Khalid

Jummani²,

Kanagaraj³

et al. 2010

Emergency Medicine Journal

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“…20 The rate of true fractures among patients with suspected scaphoid fractures at our institution was estimated at 5% based on data from previously published studies. [21][22][23][24][25][26][27][28][29][30][31][32] By using this estimate, we calculated PPVs and NPVs using Bayes' theorem. We also calculated the PPV over a range of possible prevalence levels (Fig.…”

Section: Discussionmentioning

confidence: 99%

Computed Tomography of Suspected Scaphoid Fractures

Adey

Souer

Lozano-Calderón

et al. 2007

The Journal of Hand Surgery

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“…A "positive" US is defined as pain produced when US imaging commences. [18][19][20][21][22][23] Other physical examination maneuvers include assessment of pain in the scaphoid with ulnar or radial deviation of the wrist or with resisted supination (Data Supplement S6, available as supporting information in the online version of this paper) and pronation. 24 Two diagnostic meta-analyses have been published in the orthopedic surgery literature to evaluate advanced imaging modalities for scaphoid fracture, but none focus on history and physical examination diagnostic accuracy or ED-specific pretest probability, all necessary to facilitate Bayesian reasoning for bedside clinicians.…”

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confidence: 99%

Adult Scaphoid Fracture

Carpenter

Pines

Schuur

et al. 2014

Academic Emergency Medicine

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ObjectivesScaphoid fractures are the most common carpal fracture, representing 70% of carpal bone fractures. The diagnostic accuracy of physical examination findings and emergency medicine (EM) imaging studies for scaphoid fracture has not been previously described in the EM literature. Plain x‐rays are insufficient to rule out scaphoid fractures in a patient with a suggestive mechanism and radial‐sided tenderness on physical examination. This study was a meta‐analysis of historical features, physical examination findings, and imaging studies for scaphoid fractures not visualized on plain x‐ray in adult emergency department (ED) patients, specifically to address which types of imaging tests should be recommended in patients with persistent concern for acute fracture after ED discharge.MethodsA medical librarian and two emergency physicians (EPs) conducted a medical literature search of PUBMED and EMBASE. The original studies' bibliographies were reviewed for additional references and unpublished manuscripts were located via a hand search of EM research abstracts from national meetings. All abstracts were independently reviewed by the two physicians, and Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS‐2) was used to assess individual study quality. When two or more qualitatively similar studies were identified, meta‐analysis was conducted using Meta‐DiSc software. Primary outcomes were sensitivity, specificity, and likelihood ratios (LRs) for predictors of scaphoid fracture detected on follow‐up in patients with normal ED x‐rays.ResultsA total of 957 unique citations were identified, yielding 75 studies eligible for inclusion in this systematic review. Studies were significantly heterogeneous in design, study population, and criterion standard. The majority of studies were conducted in non‐ED settings (e.g., orthopedic clinics). No studies used accepted diagnostic research publishing guidelines, and the overall QUADAS‐2 methodologic quality was low, indicating an increased risk of bias in the estimates of diagnostic accuracy. The prevalence of scaphoid fractures ranged from 12% to 57% with the point estimate of 25% pretest probability for adult ED patients with concern for scaphoid injuries, nondiagnostic index x‐rays, and scaphoid fractures on later imaging studies. Except for the absence of snuffbox tenderness (LR– = 0.15), physical examination findings lack accuracy to rule in or rule out scaphoid fractures, and no validated clinical decision rules exist. In patients with persistent concern for injury, magnetic resonance imaging (MRI) is superior to bone scan, computed tomography (CT), or ultrasound (US) to both rule in and rule out scaphoid fractures. Both MRI and CT share the added benefit of identifying alternative etiologies for posttraumatic wrist pain.ConclusionsExcept for the absence of snuffbox tenderness, which can significantly reduce the probability of scaphoid fracture, history and physical examination alone are inadequate to rule in or rule out scaphoid fracture. MRI is the most accurate imaging test to diagnose scaphoid fractures in ED patients with no evidence of fracture on initial x‐rays. If MRI is unavailable, CT is adequate to rule in scaphoid fractures, but inadequate for ruling out scaphoid fractures.

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Diagnostic value of ultrasound in scaphoid fractures

Cited by 36 publications

References 10 publications

Role of MRI in the diagnosis of clinically suspected scaphoid fracture: analysis of 611 consecutive cases and literature review

Role of MRI in the diagnosis of clinically suspected scaphoid fracture: analysis of 611 consecutive cases and literature review

Computed Tomography of Suspected Scaphoid Fractures

Adult Scaphoid Fracture

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