Predictive Power of Distal Radial Metaphyseal Tenderness for Diagnosing Occult Fracture

Glickel, Steven Z.; Hinojosa, Lauren; Eden, Claire M.; Balutis, Elaine; Barron, O. Alton; Catalano, Louis W.

doi:10.1016/j.jhsa.2017.05.032

Cited by 3 publications

(2 citation statements)

References 15 publications

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“…Occult fractures of the tendon insertion were included in the target condition, as a physical examination test could not be expected to discriminate between an avulsion of the tendon insertion and a tear of the tendon itself [16]. An occult fracture was defined as a fracture that could not be identified on the primary plain radiographs by the physician in charge or by the skeletal radiologist [17]. The tests used were chosen because of the accuracy reported in articles, reviews and meta-analyses [6,13,[18][19][20][21][22][23], the probability of patients being able to execute the tests in an acute setting, as well as the feasibility of the tests in emergency departments and general practice.…”

Section: Clinical Testsmentioning

confidence: 99%

Interrater reliability of physical examination tests in the acute phase of shoulder injuries

Schmidt

Enger

Pripp

et al. 2021

BMC Musculoskelet Disord

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Background The physical examination is one of the cornerstones of the diagnostic process in patients with acute shoulder injuries. The discriminative properties of a given examination test depend both on its validity and reliability. The aim of the present study was to assess the interrater reliability of 13 physical examination manoeuvres for acute rotator cuff tears in patients with acute soft tissue shoulder injuries. Methods In a large walk-in orthopaedic emergency department, 120 consecutive patients ≥40 years of age were included in a diagnostic study. Patients who had follow-up within three weeks of an acute shoulder injury without fracture on radiographs were eligible. Four emergency department physicians participated as examiners. In a subset of 48 patients, the physical examination tests were performed by two physicians, randomly chosen by their work rotation. The physicians were blinded to the findings of each other and the results of the ultrasound screening. The interrater reliability was assessed by Cohen’s kappa, intraclass correlation coefficient (ICC), standard error of measurement (SEM) and Bland-Altman plots depending on whether the examination test result was registered as a binary, ordered categorical or continuous numerical variable. Results The median age was 55.5 years, 46% were female. Twenty-seven percent had a rotator cuff full-thickness tear on ultrasound screening; all but one involved the supraspinatus tendon. Cohen’s kappa for binary tests ranged from excellent to fair. Excellent agreement (kappa > 0.8) was found for the inability to abduct above 90° and abduction strength. External rotation strength expressed substantial agreement (kappa 0.7). The lowest scores were registered for Hawkins` test and the external rotation lag sign (kappa 0.25 and 0.40, respectively). The ICCs for active range of abduction and external rotation were 0.93 (0.88–0.96) and 0.84 (0.72–0.91), whereas the SEM was 15 and 9, respectively. Conclusions The results indicate that examination manoeuvres assessing abduction and external rotation range of motion and strength are more reliable than manoeuvres assessing pain in patients in the acute phase of traumatic shoulder injury. The poor agreement observed is likely to limit the validity in the present setting of two commonly used tests. Trial registration The Norwegian Regional Ethics Committee South East (2015/195).

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Section: Clinical Testsmentioning

confidence: 99%

Interrater reliability of physical examination tests in the acute phase of shoulder injuries

Schmidt

Enger

Pripp

et al. 2021

BMC Musculoskelet Disord

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“…24 Glickel et al compared point tenderness on physical examination with MRI for diagnosing occult distal radius fractures and found that physical examination alone had a 96% sensitivity rate. 25…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

Radiography of the Distal Radius

Gray

Foremny²,

Lee³

et al. 2021

Journal of Orthopaedic Trauma

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Imaging of the distal radius is of paramount importance in diagnosing injuries, indicating patients for operative or nonoperative treatment, and appropriately following patients for associated injuries and complications. Plain radiographs and fluoroscopy are the dominant imaging modalities in all settings because they are readily available and provide valuable information about the osseous structures and any instrumentation. Computed tomography can offer more information about implant placement and the level of comminution of the articular surfaces but is more expensive and exposes patients to higher doses of radiation. Magnetic resonance imaging is less commonly used but is useful for occult fractures and other associated injuries. Ultrasonography is gaining popularity in evaluating implant placement, especially regarding tendon impingement and subsequent tendon injury.

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Wrist Extensor Tendon “Floating Fat” Sign: A Strong Indicator to Recognize Occult Fractures in the Distal Radius

Gromis

Moore

Kouwenberg

et al. 2020

JBJS Case Connector

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Case: A 24-year-old woman presented with traumatic left wrist pain. X-rays were negative for fracture. Computed tomography (CT) showed hemorrhagic fatty effusions within the second and third wrist extensor tendon compartments (the “floating fat” sign) and a tiny cortical defect in the Lister's tubercle. Three weeks later, magnetic resonance imaging demonstrated a nondisplaced distal radius fracture with extensive marrow edema. Conclusion: The floating fat sign within the extensor tendon compartments is a critical sign of a distal radius fracture, which can be occult on x-ray and CT.

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Predictive Power of Distal Radial Metaphyseal Tenderness for Diagnosing Occult Fracture

Cited by 3 publications

References 15 publications

Interrater reliability of physical examination tests in the acute phase of shoulder injuries

Interrater reliability of physical examination tests in the acute phase of shoulder injuries

Radiography of the Distal Radius

Wrist Extensor Tendon “Floating Fat” Sign: A Strong Indicator to Recognize Occult Fractures in the Distal Radius

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