Fracture of the carpal navicular — Efficacy of clinical findings and improved diagnosis with six-view radiography

Mehta, Mahendra; Brautigan, Mark W.

doi:10.1016/s0196-0644(05)82039-6

Cited by 16 publications

(7 citation statements)

References 11 publications

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“…healthy individuals. 1,2 Scaphoid fractures are the most problematic to diagnose in a clinical setting because it can take up to 6 weeks for scaphoid fractures to become conclusive on plain X-ray films. It is estimated that up to 40% of scaphoid fractures are missed at first presentation.…”

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confidence: 99%

The Clinical Scaphoid Fracture: Early Computed Tomography as a Practical Approach

Nguyen

Chaudhry

Sloan

et al. 2008

annals

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Ann R Coll Surg Engl 2008; 90: 488-491 488Carpal injuries are common presentations to emergency departments, general practitioners and orthopaedic clinics. The scaphoid bone is the most commonly injured of the carpal bones accounting for 50-80% of carpal injuries and predominantly occurs in young. healthy individuals. 1,2Scaphoid fractures are the most problematic to diagnose in a clinical setting because it can take up to 6 weeks for scaphoid fractures to become conclusive on plain X-ray films. It is estimated that up to 40% of scaphoid fractures are missed at first presentation. 3,4 A recent metaanalysis of scaphoid fractures calculated that the positive predictive value of clinical examination (those who proved to be 'clinical scaphoid' warranted X-rays of scaphoid views who subsequently had scaphoid fracture) is in the range 13-69% with an average of 21%. 5This means that four out of five patients without a fracture will be unnecessarily immobilised before radiological diagnosis is confirmed. Patients and MethodsWe conducted a retrospective, chronological review of patients who attended an upper limb fracture clinic from January 2001 to October 2003 in a district general hospital. Patients with negative X-ray findings but positive clinical signs for scaphoid injury satisfied the criteria for CT. We defined clinical signs for a scaphoid injury as tenderness over the anatomical snuffbox, pain on axial loading of first metacarpal and tenderness over scaphoid tubercle in the presence of normal plain films and included patients whose plain X-rays proved inconclusive.Patients with clinical indications of scaphoid fracture but negative plain films had their wrists immobilised in a scaphoid cast in the accident unit while awaiting a hand clinic appointment.CT scans, where necessary, were carried out on the same day as review on the first presentation to the fracture

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confidence: 99%

The Clinical Scaphoid Fracture: Early Computed Tomography as a Practical Approach

Nguyen

Chaudhry

Sloan

et al. 2008

annals

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“…The scaphoid bone is the most commonly injured of the carpal bones accounting for 50-80% of carpal injuries and predominantly occurs in young healthy individuals. 1,2 The diagnosis of a scaphoid fracture can sometimes be difficult to establish, as patients may have normal radiographs early in their clinical course. Scaphoid fractures are difficult to diagnose early as the can take up to six weeks to appear radiologically.…”

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confidence: 99%

Role of early CT scan in diagnosis of occult scaphoid fractures- a prospective study

et al. 2017

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Background: Wrists injuries are one of the common presentations to emergency departments and orthopaedic clinics. The scaphoid bone is the most commonly injured of the carpal bones accounting for 50-80% of carpal injuries and predominantly occurs in young healthy individuals. Scaphoid fractures are the most problematic to diagnose in a clinical setting because it can take up to 6 weeks for scaphoid fractures to become conclusive on plain X-ray films. Aim of the study was to retrospective study was carried out to study the role of early CT scan in diagnosis of occult scaphoid fractures.Methods: A total of 123 patients presented with an acute wrist injury with subsequent signs of scaphoid injury in the absence of a diagnostic fracture on plain X-ray within the time period from June 2014 to May 2016 in a tertiary care centre.Results: This study shows that 31% of normal X-rays were pathological on CT scan and out of these; scaphoid fractures (74% of pathologies) represent a large number of patients with fractures that were missed by initial plain films.Conclusions: This study shows an extremely high false-negative rate for plain X-rays and advocate CT at the first attendance to fracture clinic if there is suspicion of scaphoid injury. An earlier diagnosis leads to appropriate management and reduces restrictions to the patient in terms of prolonged immobilization and repeated clinical reviews.

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“…Additional projections (i.e., scaphoid views) and/or magnifi cation views have been reported to increase sensitivity. 10 On the other hand, serial radiographic controls do not lead to improved diagnostic accuracy and cannot prevent unnecessary immobilization in most patients. 11 The relatively low sensitivity and specifi city of radiography necessitates the use of advanced imaging techniques for earlier fracture detection.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of multidetector computed tomography for patients with suspected scaphoid fractures and negative radiographic examinations

et al. 2011

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Fracture of the carpal navicular — Efficacy of clinical findings and improved diagnosis with six-view radiography

Cited by 16 publications

References 11 publications

The Clinical Scaphoid Fracture: Early Computed Tomography as a Practical Approach

The Clinical Scaphoid Fracture: Early Computed Tomography as a Practical Approach

Role of early CT scan in diagnosis of occult scaphoid fractures- a prospective study

Diagnostic accuracy of multidetector computed tomography for patients with suspected scaphoid fractures and negative radiographic examinations

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