Imaging the problem scaphoid

Kitsis, Christos; Taylor, Michael Alan; Chandey, J.; Smith, R R; J, Latham; Turner, S.; Wade, Paul

doi:10.1016/s0020-1383(98)00115-6

Cited by 20 publications

(11 citation statements)

References 6 publications

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“…However, two studies refer to a fall on an outstretched hand as the most common mechanism. 11,75 Another study indicated that traffic accidents accounted for 58% of scaphoid injuries, with sports (20%) and home falls (13%) as the next most common mechanisms. 54 Prior scaphoid fracture diagnostic reviews provide a narrative synopsis of physical examination in the evaluation of wrist injuries, but none provides a systematic review or meta-analysis to quantify diagnostic accuracy.…”

Section: Discussionmentioning

confidence: 99%

“…38,40,56,[65][66][67][68][69][70][71][72][73][74][75][76][77][78][79] All of the pre-1995 studies used an x-ray/clinical examination composite as the criterion standard, although the timing of this follow-up evaluation ranged from 14 days to 1 year. After 1995, several studies also included MRI as an acceptable criterion standard.…”

Section: Bone Scanmentioning

confidence: 99%

“…38,64,72,74,75,88,91,[95][96][97][98][99][100] Investigators reported a variety of criterion standards, including clinical evalua- Figure 12. Ultrasound forest plots.…”

Section: Mrimentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Bone Scanmentioning

confidence: 99%

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Adult Scaphoid Fracture

Carpenter

Pines

Schuur

et al. 2014

Academic Emergency Medicine

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“…With this strategy, about three of four patients will be unnecessarily immobilized (4). Several studies (1,(5)(6)(7)(8) show high accuracy of both high-and low-field-strength magnetic resonance (MR) imaging in the detection of radiographically occult scaphoid bone fractures.…”

mentioning

confidence: 99%

Acute Wrist Trauma: Value of a Short Dedicated Extremity MR Imaging Examination in Prediction of Need for Treatment

Nikken¹,

Oei²,

Ginai³

et al. 2005

Radiology

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“…This concludes that CT is capable of detecting the significant fractures that are likely to need intervention. However, MRI's ability to detect ligamentous and cartilaginous injuries is non debatable [25,26] .…”

Section: Which Imaging Modality Is Better?mentioning

confidence: 99%

Diagnostic imaging of suspected scaphoid fractures: A literature review

Ali

Elamin

Mohamed

2016

IJDI

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The scaphoid plays a pivotal role in the movement of the wrist carpal complex. Scaphoid fractures can be difficult to assess clinically with relatively innocuous symptoms. Avascular necrosis, mal-union or non-union can complicate scaphoid fractures. Early diagnosis and treatment improves outcomes and reduces complication rates. Imaging plays a vital role in the diagnosis and management of such fractures, reducing significant long-term disability. We will discuss the different diagnostic modalities, techniques and protocols for diagnosing Scaphoid fractures.

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Imaging the problem scaphoid

Cited by 20 publications

References 6 publications

Adult Scaphoid Fracture

Adult Scaphoid Fracture

Acute Wrist Trauma: Value of a Short Dedicated Extremity MR Imaging Examination in Prediction of Need for Treatment

Diagnostic imaging of suspected scaphoid fractures: A literature review

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