The Results of Treatment of 734 Fresh, Simple Fractures of the Scaphoid

Böhler, Lorenz; Trojan, E; Jahna, H

doi:10.1016/s0266-7681(03)00077-9

Cited by 63 publications

(36 citation statements)

References 9 publications

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“…2,3,102 Furthermore, two studies have concluded that inclusion of the thumb in the splint has no effect on outcome (i.e., scaphoid cast versus Colles' cast). 11,103 The risks of immobilization are difficult to quantify, but can include difficulty performing fine hand tasks, diminished driving performance, decreased ability to perform work-related tasks, and pain or pruritis discomfort requiring splint removal. 104,105 The risk of splint-related complications requiring further management was estimated at 6.7% in one recent meta-analysis.…”

Section: Test-treatment Thresholdmentioning

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 The original studies' bibliographies were reviewed for additional references and unpublished manuscripts were located via a hand search of EM research abstracts from national meetings.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

confidence: 99%

Adult Scaphoid Fracture

Carpenter

Pines

Schuur

et al. 2014

Academic Emergency Medicine

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“…Scaphoid fractures can be accompanied by unspecifi c physical complaints [1]. Standard X-rays of the wrist fail to demonstrate a fracture in up to 50% of the patients [4].…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of pseudarthrosis in untreated fractures is unknown; if treated by immobilization it varies from 4% to 12% [1,4]. The initial dislocation of the fracture and the resulting carpal collapse correspond to the degree of degenerative defects to which a pseudarthrosis will lead.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Natural History of a Missed Scaphoid Fracture

Musters

2011

J Med Cases

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Scaphoid fractures are known to be a diffi cult diagnosis since they can be accompanied by unspecifi c physical complaints. Furthermore, they are diffi cult to visualize on standard x-ray examinations. The purpose of this report is to stress the importance of adequate diagnosis and treatment of scaphoid fractures. We describe a 50-year old female, with progressive wrist pain after a skiing accident, who was diagnosed with an untreated scaphoid fracture. This scaphoid fracture had developed into a scaphoid non-union advanced collapse of the wrist. The scaphoid non-union advanced collapse was treated with a four-corner arthrodesis and a Wafer procedure, which ultimately led to an acceptable situation. This report presents a rare complication of a missed scaphoid fracture. X-rays of the wrist commonly fail to demonstrate fractures of the scaphoid bone. Therefore more invasive imaging techniques must be used to diagnose a scaphoid fracture.

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“…I would ask those who designed the impact factor and those in the administration departments of universities who consider The Journal of Hand Surgery of so little importance whether they would be concerned if they discovered that a surgeon who is about to operate on their hand does not subscribe to any journal of hand surgery and has not read any such journal in the past 10 years, preferring to read Nature instead. Regardless of our impact factor, I feel that we have published articles of great value to the hand surgeons over the past few years and the impact factor should be regarded with caution as it can be manipulated (Ahmed and Goldie, 2002;Ahmed et al, 2003;Al Qattan et al, 2003;Al-Qattan, 2002, 2003aAmadio, 2002;Apergis et al, 2002;Arai et al, 2002;Baer et al, 2002;Bahm and Gilbert, 2002;Baliarsing et al, 2002;Barr et al, 2003;Bassi et al, 2003;Bayat et al, 2002;Bellew and Kay, 2003;Bhaskaranand and Navadgi, 2002;Bhatia et al, 2002;Bickert et al, 2002;Bindra et al, 2003;Birch, 2002;Bisson et al, 2003;Bohler, 2003;Bohler et al, 2003;Haussmann, 2002, 2003;Braga-Silva et al, 2002;Britto and Elliot, 2002;Bruner et al, 2003;Calif et al, 2002;Cao et al, 2002;Cavallo et al, 2003;Cawrse and Sammut, 2003;Cederlund et al, 2003;Chang and Jones, 2002;Chester et al, 2002;Chou et al, 2003;…”

mentioning

confidence: 99%

Editorial: An age of Enlightenment or Information Overload?

Davis¹

2004

Journal of Hand Surgery

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The Results of Treatment of 734 Fresh, Simple Fractures of the Scaphoid

Cited by 63 publications

References 9 publications

Adult Scaphoid Fracture

Adult Scaphoid Fracture

The Natural History of a Missed Scaphoid Fracture

Editorial: An age of Enlightenment or Information Overload?

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