The Value of Radiographs and Bone Scintigraphy in Suspected Scaphoid Fracture

Buul, M. M. C. Tiel-Van; Beek, Edwin Jacques Rudolph van; Borm, J. J. J.; Gubler, F. M.; Broekhuizen, A.H.; Royen, E. A. Van

doi:10.1016/0266-7681(93)90074-p

Cited by 98 publications

(55 citation statements)

References 17 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%

“…Dias 57 noted between-resident interrater kappa of 0.30 compared to 0.43 for senior residents, 0.53 for orthopedic surgeons, and 0.80 for radiologists. Tiel-van Buul et al 55,56 reported interrater kappa 0.76 for the initial x-ray, but only 0.40 when the initial x-rays are negative. Low and Raby 59 reported kappa estimates ranging from 0.18 to 0.53 between four clinicians.…”

Section: Radiographymentioning

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%

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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: Radiographymentioning

confidence: 99%

Section: Radiographymentioning

confidence: 99%

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Adult Scaphoid Fracture

Carpenter

Pines

Schuur

et al. 2014

Academic Emergency Medicine

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“…Scaphoid fractures can be difficult to diagnose on plain films, with reported sensitivities between 70% and 86%. 31 Hence in an acute setting, any suspected scaphoid injury should be managed with a splint. CT or MRI may be needed to make the diagnosis of subtle or stress fractures.…”

Section: Wrist and Hand Fracturesmentioning

confidence: 99%

Pediatric Upper-Extremity Fractures

Arora¹,

Fichadia²,

Hartwig³

et al. 2014

Pediatr Ann

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Upper-extremity fractures account for more than half of childhood bony injuries. The frequency of injury increases with increasing mobility. The most common mechanism is a fall on an outstretched hand while playing. Optimal management requires knowledge of the normal anatomy and variants unique to pediatric bones. The physician needs to maintain a high level of suspicion for growth plate injuries because if unrecognized, these may result in growth arrest. Although the vast majority of pediatric upper-extremity fractures will heal rapidly with minimal intervention, physicians should be aware of the complications that can arise from these injuries.

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“…Patients who visited the Emergency Department with an acute trauma and a suspected scaphoid fracture after physical examination but no evidence of a scaphoid fracture on plain radiographs underwent at our institution bone scintigraphy [5][6][7][8][9][10][11]. We noticed that bone scintigraphy detected many other occult carpal and distal radius fractures in these patients with a suspected scaphoid fracture.…”

Section: Introductionmentioning

confidence: 99%

Occult Fractures in the Carpal Region: Incidental Findings on Bone Scintigraphy

Zoakman¹,

Leerdam²,

Beeres³

et al. 2013

OJO

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The aim of this study was to evaluate the number and distribution of fractures around the wrist found on bone scintigraphy in patients with a clinically suspected scaphoid fracture and negative initial radiographs. We retrospectively included 445 consecutive patients with a suspected scaphoid fracture who underwent routine bone scintigraphy. None of the radiographs showed evidence of a fracture. We analyzed the type and number of other fractures incidentally found on bone scintigraphy. On average, bone scintigraphy was done in 4 days (1 -9). The outcome of bone scintigraphy: 80 (18.0%) a scaphoid fracture, 145 (32.6%) another fracture in the carpal region, 208 (46.7%) normal and the diagnosis of 12 (2.8%) was unclear. In the present study, we demonstrated that in patients with a clinically suspected scaphoid fracture and negative initial radiographs, bone scintigraphy detected in many cases (64.4%) other fractures in the carpal region. This suggests that radiographs not only miss scaphoid but also many other carpal and distal radius fractures. Solutions should be found to solve this problem and probably advanced imaging techniques like CT, MRI or bone scintigraphy should be used in the correct clinical scenario.

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The Value of Radiographs and Bone Scintigraphy in Suspected Scaphoid Fracture

Cited by 98 publications

References 17 publications

Adult Scaphoid Fracture

Adult Scaphoid Fracture

Pediatric Upper-Extremity Fractures

Occult Fractures in the Carpal Region: Incidental Findings on Bone Scintigraphy

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