Scaphoid Fractures: Evaluation with High-Spatial-Resolution US—Initial Results

Herneth, Andreas M.; Siegmeth, A.; Bader, Till R.; Ba‐Ssalamah, Ahmed; Lechner, G; Metz, V.; Grabenwoeger, Florian

doi:10.1148/radiology.220.1.r01jl15231

Cited by 82 publications

(85 citation statements)

References 37 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%

“…46,[49][50][51][52][53][54] Among the five fat pad studies, four were European, while one did not specify its geographic locale. Two were ED-based and all were retrospective.…”

Section: Radiographymentioning

confidence: 99%

“…Tiel-van Buul et al 54 retrospectively compared x-rays (at presentation, 14 days postinjury, and 6 weeks) against radionuclide imaging (200 MBq 99m Tc-MDP) performed at an average of 10 days postinjury. Within 3 days of injury, Herneth et al 46 prospectively evaluated "conventional radiology" (posteroanterior, lateral, semipronated oblique scaphoid, radial oblique scaphoid, and posteroanterior views with the wrist in ulnar deviation) with radiologists' high spatial resolution US using MRI (short inversion time inversion recovery, coronal T1-weighted spin-echo, and transverse T2*-weighted three-dimensional gradient-echo sequences) as the criterion standard. One study evaluated the accuracy of the initial ED x-ray using 6-month follow-up clinical evaluation as the criterion standard.…”

Section: Radiographymentioning

confidence: 99%

“…46,[83][84][85][86][87] The reported criterion standards included x-rays within 14 days, 83,84 CT within 3 days, 86,87 or MRI. 46 All studies used US obtained and interpreted by musculoskeletal radiologists.…”

Section: Usmentioning

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%

“…46,[49][50][51][52][53][54] Among the five fat pad studies, four were European, while one did not specify its geographic locale. Two were ED-based and all were retrospective.…”

Section: Radiographymentioning

confidence: 99%

Section: Radiographymentioning

confidence: 99%

Section: Usmentioning

confidence: 99%

See 2 more Smart Citations

Adult Scaphoid Fracture

Carpenter

Pines

Schuur

et al. 2014

Academic Emergency Medicine

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show abstract

“…The radiocarpal and midcarpal recesses were inspected in the sagittal plane, for both the dorsal and volar planes of examination. [3,4] The emergency medicine physician was asked to assess the continuity of the scaphoid cortex (seen as a smooth, thin, hyperechoic line) and the presence of fluid effusion in the radioscaphoid and scaphotrapezium trapezoid spaces (Fig. 2).…”

Section: Methodsmentioning

confidence: 99%