Scaphoid fractures: A higher order analysis of clinical tests and application of clinical reasoning strategies

Burrows, Blayne; Moreira, Paula Leão; Murphy, Chris; Sadi, Jackie; Walton, David M.

doi:10.1016/j.math.2014.05.007

Cited by 7 publications

(8 citation statements)

References 33 publications

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“…Nonetheless, one needs to keep in mind that, although scaphoid fractures are the most frequently injured carpal bones, the consequences of fractures of other carpal bones should not be underestimated. All previously available systematic reviews only examined diagnostic tests for scaphoid fractures [32][33][34][35][36][37][38][39], while in practice it is often not quite clear during the diagnostic process which hand or wrist anatomical structure or tissue (soft tissue or bone) is affected.…”

Section: Diagnostic Accuracy Of Imaging Of Carpal Fracturesmentioning

confidence: 99%

“…Currently, there are several systematic reviews available on the diagnostic accuracy of tests for the diagnosis of hand and wrist fractures, as presented in Table 1 [32][33][34][35][36][37][38][39]. Of these, only the review by Carpenter et al used 'history' as a keyword in their search terms, but they could not find studies assessing the diagnostic accuracy of history for scaphoid fractures [32].…”

Section: Introductionmentioning

confidence: 99%

“…Of these, only the review by Carpenter et al used 'history' as a keyword in their search terms, but they could not find studies assessing the diagnostic accuracy of history for scaphoid fractures [32]. All the available systematic reviews only examined diagnostic tests for scaphoid fractures [32][33][34][35][36][37][38][39], while in practice it is often not quite clear during the diagnostic process which hand or wrist anatomical structure or tissue (soft tissue or bone) is affected. Moreover, these reviews focused predominantly on imaging as a diagnostic tool, while in clinical practice a diagnosis is mainly made on history taking and physical examination.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Diagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review update

Krastman

Mathijssen

Bierma-Zeinstra

et al. 2020

BMC Musculoskelet Disord

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Background: The standard diagnostic work-up for hand and wrist fractures consists of history taking, physical examination and imaging if needed, but the supporting evidence for this work-up is limited. The purpose of this study was to systematically examine the diagnostic accuracy of tests for hand and wrist fractures. Methods: A systematic search for relevant studies was performed. Methodological quality was assessed and sensitivity (Se), specificity (Sp), accuracy, positive predictive value (PPV) and negative predictive value (NPV) were extracted from the eligible studies. Results: Of the 35 eligible studies, two described the diagnostic accuracy of history taking for hand and wrist fractures. Physical examination with or without radiological examination for diagnosing scaphoid fractures (five studies) showed Se, Sp, accuracy, PPV and NPV ranging from 15 to 100%, 13-98%, 55-73%, 14-73% and 75-100%, respectively. Physical examination with radiological examination for diagnosing other carpal bone fractures (one study) showed a Se of 100%, with the exception of the triquetrum (75%). Physical examination for diagnosing phalangeal and metacarpal fractures (one study) showed Se, Sp, accuracy, PPV and NPV ranging from 26 to 55%, 13-89%, 45-76%, 41-77% and 63-75%, respectively. Imaging modalities of scaphoid fractures showed predominantly low values for PPV and the highest values for Sp and NPV (24 studies). Magnetic Resonance Imaging (MRI), Computed Tomography (CT), Ultrasonography (US) and Bone Scintigraphy (BS) were comparable in diagnostic accuracy for diagnosing a scaphoid fracture, with an accuracy ranging from 85 to 100%, 79-100%, 49-100% and 86-97%, respectively. Imaging for metacarpal and finger fractures showed Se, Sp, accuracy, PPV and NPV ranging from 73 to 100%, 78-100%, 70-100%, 79-100% and 70-100%, respectively. Conclusions: Only two studies were found on the diagnostic accuracy of history taking for hand and wrist fractures in the current review. Physical examination was of moderate use for diagnosing a scaphoid fracture and of limited use for diagnosing phalangeal, metacarpal and remaining carpal fractures. MRI, CT and BS were found to be moderately accurate for the definitive diagnosis of clinically suspected carpal fractures.

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Section: Diagnostic Accuracy Of Imaging Of Carpal Fracturesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Diagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review update

Krastman

Mathijssen

Bierma-Zeinstra

et al. 2020

BMC Musculoskelet Disord

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

“…Of these, only the review by Carpenter et al used 'history' as a keyword in their search terms, but they could not find studies assessing the diagnostic accuracy of history for scaphoid fractures [37]. All the available systematic reviews only examined diagnostic tests for scaphoid fractures [32][33][34][35][36][37][38][39], while in practice it is often not quite clear during the diagnostic process which hand or wrist anatomical structure or tissue (soft tissue or bone) is affected. Moreover, these reviews focused predominantly on imaging as a diagnostic tool, while in clinical practice a diagnosis is mainly made on history taking and physical examination.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review update.

Krastman

Mathijssen

Bierma-Zeinstra

et al. 2019

Preprint

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Background The standard diagnostic work-up for hand and wrist fractures consists of history taking, physical examination and imaging if needed, but the supporting evidence for this work-up is limited. The purpose of this study was to systematically examine the diagnostic accuracy of tests for hand and wrist fractures. Methods A systematic search for relevant studies was performed. Methodological quality was assessed and sensitivity (Se), specificity (Sp), accuracy, positive predictive value (PPV) and negative predictive value (NPV) were extracted from the eligible studies. Results Of the 35 eligible studies, two described the diagnostic accuracy of history taking for hand and wrist fractures. Physical examination with or without radiological examination for diagnosing scaphoid fractures (five studies) showed Se, Sp, accuracy, PPV and NPV ranging from 15-100%, 13-98%, 55-73%, 14-73% and 75-100%, respectively. Physical examination with radiological examination for diagnosing other carpal bone fractures (one study) showed a Se of 100%, with the exception of the triquetrum (75%). Physical examination for diagnosing phalangeal and metacarpal fractures (one study) showed Se, Sp, accuracy, PPV and NPV ranging from 26-55%, 13-89%, 45-76%, 41-77% and 63-75%, respectively. Imaging modalities of scaphoid fractures showed predominantly low values for PPV and the highest values for Sp and NPV (24 studies). Magnetic Resonance Imaging (MRI), Computed Tomography (CT), Ultrasonography (US) and Bone Scintigraphy (BS) were comparable in diagnostic accuracy for diagnosing a scaphoid fracture, with an accuracy ranging from 85-100%, 79-100%, 49-100% and 86-97%, respectively. Imaging for metacarpal and finger fractures showed Se, Sp, accuracy, PPV and NPV ranging from 73-100%, 78-100%, 70-100%, 79-100% and 70-100%, respectively. Conclusions Only two studies were found on the diagnostic accuracy of history taking for hand and wrist fractures in the current review. Physical examination was of moderate use for diagnosing a scaphoid fracture and of limited use for diagnosing phalangeal, metacarpal and remaining carpal fractures. MRI, CT and BS were found to be moderately accurate for the definitive diagnosis of clinically suspected carpal fractures.

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Skaphoidfrakturen

Schädel-Höpfner,

Windolf,

Lögters

et al. 2023

Unfallchirurgie

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Scaphoid fractures: A higher order analysis of clinical tests and application of clinical reasoning strategies

Cited by 7 publications

References 33 publications

Diagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review update

Diagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review update

Diagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review update.

Skaphoidfrakturen

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