Does preservation of active range of motion after acute elbow injury rule out the need for the radiography?

Diagnostic accuracy of clinical tests to rule out elbow fracture: a systematic review

“…Full results of the included studies are available in Supplementary Material 4 . As can be seen from Table 3 , all studies are characterized by a low risk of bias in the domains related to applicability; the study with the lowest risk of bias appears to be that by Amiri et al [ 21 ].…”

“…Among the five studies [ 13 , 14 , 21 , 22 ] included in this subgroup, very high sensitivity values emerged, reaching 100% in the studies by Darracq et al [ 13 ], Vinson et al [ 14 ]. Conversely, specificity achieved high values only in the studies of Amiri et al [ 21 ] and Darracq et al [ 13 ] (88%–97%).…”

“…Among the five studies [ 13 , 14 , 21 , 22 ] included in this subgroup, very high sensitivity values emerged, reaching 100% in the studies by Darracq et al [ 13 ], Vinson et al [ 14 ]. Conversely, specificity achieved high values only in the studies of Amiri et al [ 21 ] and Darracq et al [ 13 ] (88%–97%). In Lennon et al’s study [ 23 ], diagnostic accuracy values emerged that strongly disagree with those of the rest of the studies, showing a high specificity and low sensitivity of the elbow ROM test.…”

“…Five studies [13,14,[21][22][23] (1,050 total patients) compared the elbow's range of motion (ROM) as an index test versus X-ray as a reference standard, four studies [24][25][26][27] (654 patients with fracture, 2,024 total) compared the ROM in elbow extension as an index test to X-ray as a reference standard, and three studies [28][29][30] (1,411 total patients) compared clinical clusters that included the evaluation of ROM in elbow extension and tenderness points to X-ray as a reference standard. In four studies [14,23,24,27], the values of +LR and −LR wer e also present, while, in eight studies [14,[21][22][23][24][25]27,29],VPP and VPN values were reported; in other cases, the data were extrapolated by the researchers (GDM and PC) using specific online calculators and added to the summary table of diagnostic accuracy values. Two studies [22,29] investigated this condition in children, and 10 studies investigated the same in children and in adults [13,14,21,[24][25][26]28,30].…”

“…In four studies [14,23,24,27], the values of +LR and −LR wer e also present, while, in eight studies [14,[21][22][23][24][25]27,29],VPP and VPN values were reported; in other cases, the data were extrapolated by the researchers (GDM and PC) using specific online calculators and added to the summary table of diagnostic accuracy values. Two studies [22,29] investigated this condition in children, and 10 studies investigated the same in children and in adults [13,14,21,[24][25][26]28,30]. The total number of fractures was not calculated in relation to the global sample divided by subgroups of different index tests.…”