Real-time digital contrast enhancement and magnification in the assessment of scaphoid and other wrist injuries

Davies, A. M.; Morris, Ellen; Manns, R.A.; Fowler, J. David; Wellings, Richard

doi:10.1259/0007-1285-63-756-934

Cited by 6 publications

(3 citation statements)

References 7 publications

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“…42 Five studies also reported interrater kappa values for x-ray between radiologists and hand surgeons. [55][56][57][58][59] Several studies reported on x-ray imaging techniques that are not readily available in the ED, including carpal box x-rays, 60,61 digital contrast enhancement, 62 and dual x-ray absorption. 63 Waeckerle 42 reported that the initial x-ray sensitivity was 80% with 100% specificity (LR+ = infinity, LR-= 0.20).…”

Section: Radiographymentioning

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 The original studies' bibliographies were reviewed for additional references and unpublished manuscripts were located via a hand search of EM research abstracts from national meetings.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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Section: Radiographymentioning

confidence: 99%

Adult Scaphoid Fracture

Carpenter

Pines

Schuur

et al. 2014

Academic Emergency Medicine

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“…Radiography is a cheap and widely used primary imaging technique in the diagnosis of clinically suspected scaphoid fractures (3, 7, 9, 20, 22). However, several reports conclude that initial and follow‐up conventional radiographs are not reliable for the detection of scaphoid fractures (22, 24).…”

mentioning

confidence: 99%

Modified Carpal Box Technique in the Diagnosis of Suspected Scaphoid Fractures

Tóth¹,

Mester²,

Cseh³

et al. 2003

Acta Radiologica

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“…Radiography is a cheap and widely used primary imaging technique in the diagnosis of clinically suspected scaphoid fractures (3,7,9,20,22). However, several reports conclude that initial and follow-up conventional radiographs are not reliable for the detection of scaphoid fractures (22,24).…”

mentioning

confidence: 99%