How Trustworthy Are Clinical Examinations and Plain Radiographs for Diagnosis of Scaphoid Fractures?

Ghane, Mohammad Reza; Rezaee‐Zavareh, Mohammad Saeid; Emami-Meibodi, Mohammad Kazem; Dehghani, V.

doi:10.5812/traumamon.23345

Cited by 8 publications

(5 citation statements)

References 15 publications

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“…For sensitivity and specificity, this was highest for scaphoid tubercle tenderness with 95.23% respectively 74.07% for clinical examination, followed by tenderness of the anatomical snuff box and compression with much lower specificity of 29.62% each. 7 For diagnostic imaging, we found only 13 studies which included 100 or more patients. In addition, the majority of studies on this topic were conducted prior to 2010, which is at risk of being outdated considering the rapid advance of radiographic technology.…”

Section: Discussionmentioning

confidence: 99%

“…6 This may vary between the tenderness of the scaphoid tubercle with a sensitivity of 95.23% and specificity of 74.07%, tenderness of the anatomical snuffbox (sensitivity ¼ 85.71% and specificity 29.62%), or a direct compression test (sensitivity ¼ 42.85% and specificity ¼ 29.62%). 7 Radiographic assessment typically includes four views, which include posteroanterior, true lateral, posteroanterior in ulnar deviation, and oblique views. These views are sensitive in 70 to 90% of cases and miss up to 16% of cases, which is why previous studies have recommended advanced imaging modalities.…”

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confidence: 99%

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Systematic Review of Diagnosis of Clinically Suspected Scaphoid Fractures

Bäcker

Strauch

2019

Jnl Wrist Surg

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Background Scaphoid fracture accounts for approximately 15% of acute wrist fractures. Clinical examination and plain X-rays are commonly used to diagnose the fracture, but this approach may miss up to 16% of fractures in the absence of clear-cut lucent lines on plain radiographs. As such, additional imaging may be required. It is not clear which imaging modality is the best. The goal of this study is to summarize the current literature on scaphoid fractures to evaluate the sensitivity, specificity, and accuracy of four different imaging modalities. Case Description A systematic-review and meta-analysis was performed. The search term “scaphoid fracture” was used and all prospective articles investigating magnetic resonance imaging (MRI), computed tomography (CT), bone scintigraphy, and ultrasound were included. In total, 2,808 abstracts were reviewed. Of these, 42 articles investigating 51 different diagnostic tools in 2,507 patients were included. Literature Review The mean age was 34.1 ± 5.7 years, and the overall incidence of scaphoid fractures missed on X-ray and diagnosed on advanced imaging was 21.8%. MRI had the highest sensitivity and specificity for diagnosing scaphoid fractures, which were 94.2 and 97.7%, respectively, followed by CT scan with a sensitivity and specificity at 81.5 and 96.0%, respectively. The sensitivity and specificity of ultrasound were 81.5 and 77.4%, respectively. Significant differences between MRI, bone scintigraphy, CT, and ultrasound were identified. Clinical Relevance MRI has higher sensitivity and specificity than CT scan, bone scintigraphy, or ultrasound. Level of Evidence This is a Level II systematic review.

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Section: Discussionmentioning

confidence: 99%

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Systematic Review of Diagnosis of Clinically Suspected Scaphoid Fractures

Bäcker

Strauch

2019

Jnl Wrist Surg

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“…It is crucial to acknowledge that a comprehensive clinical examination and detailed history-taking play a vital role in achieving accurate diagnoses by correlating symptoms with radiological findings. For example, tenderness within the anatomical snuffbox has been identified as the single most specific clinical marker for scaphoid fracture [ 21 ]. Additionally, thorough history-taking and clinical context have been shown to enhance the accuracy of radiograph interpretation, such as in the case of chest films [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy and Confidence in Management of Forearm and Hand Fractures Among Foundation Doctors in the Accident and Emergency Department: Survey Study

Gompels¹,

Rusby²,

Limb³

et al. 2023

JMIR Form Res

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Background Accurate interpretation of radiographs is crucial for junior doctors in the accident and emergency (A&E) department (the emergency medicine department). However, it remains a significant challenge and a leading cause of diagnostic errors. Objective This study aimed to evaluate the accuracy and confidence of foundation doctors (doctors within their first 2 years of qualifying) in correctly interpreting and managing forearm and hand fractures on plain radiographs. Methods A total of 42 foundation doctors with less than 2 years of experience and no prior emergency medicine training who worked in a large district general hospital participated in a web-based questionnaire. The questionnaire consisted of 3 case studies: distal radius fracture, scaphoid fracture, and a normal radiograph. Respondents were required to identify the presence or absence of a fracture, determine the fracture location, suggest appropriate management, and rate their confidence on a Likert scale. Results Overall, 48% (61/126) of respondents accurately identified the presence and location of fractures. The correct management option was chosen by 64% (81/126) of respondents. The median diagnostic confidence score was 4 of 10, with a mean diagnostic certainty of 4.4 of 10. Notably, respondents exhibited a significantly lower confidence score for the normal radiograph compared to the distal radius fracture radiograph (P=.01). Conclusions This study reveals diagnostic uncertainty among foundation doctors in interpreting plain radiographs, with a notable inclination toward overdiagnosing fractures. The findings emphasize the need for close supervision and senior support to mitigate diagnostic errors. Further training and educational interventions are warranted to improve the accuracy and confidence of junior doctors in radiographic interpretation. This study has several limitations, including a small sample size and reliance on self-reported data. The findings may not be generalizable to other health care settings or specialties. Future research should aim for larger, more diverse samples and explore the impact of specific educational interventions on diagnostic accuracy and confidence.

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“…35,36 These rates reflect the poor sensitivity of conventional radiological assessment of scaphoid fractures. [37][38][39] This, together with the large number of false positives, implies that follow-up radiographs cannot be considered as a reference in the diagnosis of scaphoid fractures. 36,38,40,41 Interobserver agreement for MRI assessment of scaphoid fracture by four and five observers in cohorts of 79 and 64 patients, with a similar percentage of scaphoid fractures among those suspected clinically as in our study, was κ = 0.67 and κ = 0.44 respectively, representing moderate to substantial agreement.…”

Section: Discussionmentioning

confidence: 99%

The interobserver reliability of the diagnosis and classification of scaphoid fractures using high-resolution peripheral quantitative CT

Daniels

Wyers

Janzing³

et al. 2020

The Bone & Joint Journal

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Aims Besides conventional radiographs, the use of MRI, CT, and bone scintigraphy is frequent in the diagnosis of a fracture of the scaphoid. However, which techniques give the best results remain unknown. The investigation of a new imaging technique initially requires an analysis of its precision. The primary aim of this study was to investigate the interobserver agreement of high-resolution peripheral quantitative CT (HR-pQCT) in the diagnosis of a scaphoid fracture. A secondary aim was to investigate the interobserver agreement for the presence of other fractures and for the classification of scaphoid fracture. Methods Two radiologists and two orthopaedic trauma surgeons evaluated HR-pQCT scans of 31 patients with a clinically-suspected scaphoid fracture. The observers were asked to determine the presence of a scaphoid or other fracture and to classify the scaphoid fracture based on the Herbert classification system. Fleiss kappa statistics were used to calculate the interobserver agreement for the diagnosis of a fracture. Intraclass correlation coefficients (ICCs) were used to assess the agreement for the classification of scaphoid fracture. Results A total of nine (29%) scaphoid fractures and 12 (39%) other fractures were diagnosed in 20 patients (65%) using HR-pQCT across the four observers. The interobserver agreement was 91% for the identification of a scaphoid fracture (95% confidence interval (CI) 0.76 to 1.00) and 80% for other fractures (95% CI 0.72 to 0.87). The mean ICC for the classification of a scaphoid fracture in the seven patients diagnosed with scaphoid fracture by all four observers was 73% (95% CI 0.42 to 0.94). Conclusion We conclude that the diagnosis of scaphoid and other fractures is reliable when using HR-pQCT in patients with a clinically-suspected fracture. Cite this article: Bone Joint J 2020;102-B(4):478–484.

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How Trustworthy Are Clinical Examinations and Plain Radiographs for Diagnosis of Scaphoid Fractures?

Cited by 8 publications

References 15 publications

Systematic Review of Diagnosis of Clinically Suspected Scaphoid Fractures

Systematic Review of Diagnosis of Clinically Suspected Scaphoid Fractures

Diagnostic Accuracy and Confidence in Management of Forearm and Hand Fractures Among Foundation Doctors in the Accident and Emergency Department: Survey Study

The interobserver reliability of the diagnosis and classification of scaphoid fractures using high-resolution peripheral quantitative CT

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