Diagnosis of occult scaphoid fractures by intrasound vibration

Finkenberg, John; Hoffer, Eric K.; Kelly, Cindy; Zinar, Daniel M.

doi:10.1016/0363-5023(93)90236-v

Cited by 21 publications

(5 citation statements)

References 7 publications

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“…Fifteen studies published between 1982 and 2009 assessed the diagnostic accuracy for various physical examination tests, either in isolation or in combinations, including signs such as swelling or discoloration, as well as symptoms like anatomical snuffbox tenderness, scaphoid tubercle tenderness, clamp sign, resisted pronation or supination, thumb compression-induced pain, and US pain. 5,14,[17][18][19][21][22][23]39,[41][42][43][44][45][46] None were from the United States, and 12 were from Europe. These were all prospective case series, and 11 were ED-based, while two were orthopedic clinic studies and two did not report their clinical settings.…”

Section: History and Physical Examinationmentioning

confidence: 99%

“…A "positive" US is defined as pain produced when US imaging commences. [18][19][20][21][22][23] Other physical examination maneuvers include assessment of pain in the scaphoid with ulnar or radial deviation of the wrist or with resisted supination (Data Supplement S6, available as supporting information in the online version of this paper) and pronation. 24 Two diagnostic meta-analyses have been published in the orthopedic surgery literature to evaluate advanced imaging modalities for scaphoid fracture, but none focus on history and physical examination diagnostic accuracy or ED-specific pretest probability, all necessary to facilitate Bayesian reasoning for bedside clinicians.…”

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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: History and Physical Examinationmentioning

confidence: 99%

mentioning

confidence: 99%

Adult Scaphoid Fracture

Carpenter

Pines

Schuur

et al. 2014

Academic Emergency Medicine

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“…2 Furthermore, even with appropriate use of these guidelines many patients without bony injury will have unnecessary x rays.3 A paper published in 1993 in the J7ournal of Hand Surgery suggests a possible approach to further reducing the use of unnecessary x rays. 4 Finkenberg et al reported that an inexpensive intrasound device could detect occult fractures of the scaphoid more effectively than x ray.…”

mentioning

confidence: 99%

A pilot study to assess the sensitivity and specificity of an intrasound device in the diagnosis of ankle fractures.

Dancocks

Rouse²,

Hiscox³

1997

Emergency Medicine Journal

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Objective-To investigate the use of a simple intrasound device in the detection of malleolar fractures in the accident and emergency (A&E) department. Methods-Patients aged 16 to 70 years with ankle injuries presenting within 24 hours were considered for inclusion in the study. Those patients with bony tenderness, inability to weight bear, and swelling were examined with a simple intrasound device before x ray examination. A positive result of discomfort, pain, withdrawal response, or combinations of these was noted.Results-The device had a sensitivity of 85% and a specificity of 52% in detecting malleolar fractures. Conclusions-The use ofintrasound in the detection of malleolar fractures cannot be relied upon alone, but it may help to limit the number of x rays taken unnecessarily. A further study is proposed to confirm these findings.

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“…Αξονική τομογραφία σκαφοειδούς -ψευδάρθρωση της μεσότητας του οστού Το σπινθηρογράφημα έχει ακόμα μιά σχετική αξία γιατί όταν είναι αρνητικό επιτρέπει την άμεση κινητοποίηση του καρπού, ζήτημα σημαντικό σε άτομα υψηλών απαιτήσεων (πχ αθλητές). Η χρήση μικροδονήσεων στην διάγνωση των μή ακτινολογικά ορατών (occult) καταγμάτων [Finkenberg, 1993] [Amadio 1989, Linscheid 1983]. Ο Gilford [1943] αναγνώρισε την τάση που έχει η μεσοκάρπια άρθρωση να κατερειπώνεται (collapse) όταν το σκαφοειδές αναπτύσσει ψευδάρθρωση.…”

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Ο Ρόλος Των Μικρών Υλικών Οστεοσύνθεσης Στη Ψευδάρθρωση Του Σκαφοειδούς Οστού Του Καρπού

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Diagnosis of occult scaphoid fractures by intrasound vibration

Cited by 21 publications

References 7 publications

Adult Scaphoid Fracture

Adult Scaphoid Fracture

A pilot study to assess the sensitivity and specificity of an intrasound device in the diagnosis of ankle fractures.

Ο Ρόλος Των Μικρών Υλικών Οστεοσύνθεσης Στη Ψευδάρθρωση Του Σκαφοειδούς Οστού Του Καρπού

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