Clinical Diagnostic Evaluation for Scaphoid Fractures: A Systematic Review and Meta-Analysis

Mallee, Wouter H.; Henny, Erik P.; Dijk, C. Niek van; Kamminga, Sjoerd P.; Enst, Wynanda A. van; Kloen, Peter

doi:10.1016/j.jhsa.2014.06.004

Cited by 40 publications

(44 citation statements)

References 27 publications

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“…Therefore, overtreatment will still be an issue in clinically suspected scaphoid fractures. The lack of specificity is frequently addressed in scaphoid fracture diagnostics [3,7]; however, the results of this study show a reduction in unnecessary diagnostics and treatment of more than 15%. Second, the AUC of this clinical prediction model after internal validation rule is 0.72.…”

Section: Limitationsmentioning

confidence: 61%

“…This is a large prospective study on the diagnosis of wrist injuries including 68 scaphoid fractures. The variables for clinical assessment were selected by performing a thorough systematic review [7] and analysis encompasses the use of robust statistical and study design methodology [15][16][17]. The inclusion of all acute wrist injuries ensured that all scaphoid fractures were included in the analysis to get an accurate representation of clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…Both demographics and clinical tests were implemented in the CRF (Table 1). These variables were based on a recent review [7]: age, sex, presence of swelling in the anatomic snuffbox (ASB), tenderness in the ASB, painful longitudinal thumb compression, scaphoid tubercle tenderness and pain over scaphoid with ulnar deviation. Definitive management was not interfered by the outcome of the CRF.…”

Section: Methodsmentioning

confidence: 99%

“…On average, 80% of these patients do not have a scaphoid fracture [8], resulting in substantial overtreatment (e.g., immobilization), unnecessary follow-up imaging and substantial impact on work. Clinical assessment of possible scaphoid fractures in the emergency department (ED) is limited due to a lack of evidence supporting adequate tests [7].…”

Section: Introductionmentioning

confidence: 99%

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Detecting scaphoid fractures in wrist injury: a clinical decision rule

Mallee

Walenkamp

Mulders

et al. 2020

Arch Orthop Trauma Surg

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Introduction The aim of this study was to develop and validate an easy to use clinical decision rule, applicable in the ED that limits the number of unnecessary cast immobilizations and diagnostic follow-up in suspected scaphoid injury, without increasing the risk of missing fractures. Methods A prospective multicenter study was conducted that consisted of three components: (1) derivation of a clinical prediction model for detecting scaphoid fractures in adult patients following wrist trauma; (2) internal validation of the model;(3) design of a clinical decision rule. The predictors used were: sex, age, swelling of the anatomic snuffbox, tenderness in the anatomic snuffbox, scaphoid tubercle tenderness, painful ulnar deviation and painful axial thumb compression. The outcome measure was the presence of a scaphoid fracture, diagnosed on either initial radiographs or during re-evaluation after 1-2 weeks or on additional imaging (radiographs/MRI/CT). After multivariate logistic regression analysis and bootstrapping, the regression coefficient for each significant predictor was calculated. The effect of the rule was determined by calculating the number of missed scaphoid fractures and reduction of suspected fractures that required a cast. Results A consecutive series of 893 patients with acute wrist injury was included. Sixty-eight patients (7.6%) were diagnosed with a scaphoid fracture. The final prediction rule incorporated sex, swelling of the anatomic snuffbox, tenderness in the anatomic snuffbox, painful ulnar deviation and painful axial thumb compression. Internal validation of the prediction rule showed a sensitivity of 97% and a specificity of 20%. Using this rule, a 15% reduction in unnecessary immobilization and imaging could be achieved with a 50% decreased risk of missing a fracture compared with current clinical practice. Conclusions This dataset provided a simple clinical decision rule for scaphoid fractures following acute wrist injury that limits unnecessary immobilization and imaging with a decreased risk of missing a fracture compared to current clinical practice. Clinical prediction rule 1/(1 + EXP (−(0.649662618 × if man) + (0.51353467826 × if swelling anatomic snuffbox) + (−0.79038263985 × if painful palpation anatomic snuffbox) + (0.57681198857 × if painful ulnar deviation) + (0.66499549728 × if painful thumb compression)−1.685). Trial registration Trial register NTR 2544, www.trial regis ter.nl.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Section: Limitationsmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Detecting scaphoid fractures in wrist injury: a clinical decision rule

Mallee

Walenkamp

Mulders

et al. 2020

Arch Orthop Trauma Surg

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show abstract

“…Ellis & Mahadevan (2010) indicate that increased tenderness on palpation in the AS is characteristic of the fracture of the scaphoid bone. Mallee et al (2014) add that this is the most sensitive clinical test, however, if only this test is used, up to 13% of scaphoid fractures could be undiagnosed. Tubbs et al, indicate that we must also consider the fracture of distal radius, base of the first metacarpal and the trapezium bone, as they all are part of the floor of the AS.…”

Section: Anatomical Snuffbox Uses and Clinical Significancementioning

confidence: 99%

Anatomical Snuffbox and it Clinical Significance: A Literature Review

Cerda

Sol

2015

Int. J. Morphol.

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SUMMARY:The anatomical snuffbox is a small triangular area situated in the radial part of the wrist, often used to perform clinical and surgical procedures. Despite the frequency with which this area is used, there is scarce information in literature about its details. The objective of this study is detailed knowledge of the anatomical snuffbox's anatomy and its components, the reported alterations at this portion, besides the clinical uses and significance of this area.

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Baseball Injuries in Children and Adolescents

Peljovich

2021

Hand and Wrist Injuries in Baseball

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Clinical Diagnostic Evaluation for Scaphoid Fractures: A Systematic Review and Meta-Analysis

Cited by 40 publications

References 27 publications

Detecting scaphoid fractures in wrist injury: a clinical decision rule

Detecting scaphoid fractures in wrist injury: a clinical decision rule

Anatomical Snuffbox and it Clinical Significance: A Literature Review

Baseball Injuries in Children and Adolescents

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