The role of ultrasonography in the diagnosis of occult scaphoid fractures

Abstract

Background: Ultrasonography is widely utilized by emergency physicians and radiologists to diagnose various orthopaedic diseases, including fractures. We aim to derive a definitive estimate of the diagnostic accuracy of ultrasonography in clinically suspected scaphoid fractures. Methods: We undertook a systematic review and meta-analysis of included diagnostic cohort studies that discussed the use of ultrasonography in the diagnosis of occult scaphoid fractures. We searched the National Institute for Health and Care Excellence database using the Healthcare Databases Advanced Search tool. In addition, we utilized the PubMed database to search the Medical Literature Analysis and Retrieval System Online, Excerpta Medica database, Cumulative Index of Nursing and Allied Health and Allied and Complimentary Medicine databases. Studies were included if they discuss the role of ultrasound imaging in the diagnosis of scaphoid fractures based on cortical interruption, radio-carpal effusion and scapho-trapezium-trapezoid effusion. Quality assessment was performed using the methodological index for non-randomized studies scoring system. Results: 6 non-randomized control studies met the inclusion criteria. Collectively, these included 236 patients with a mean age ranging from 18 to 41.2 years. The quality of these articles ranged between moderate and high based on the methodological index for non-randomized studies score. The mean sensitivity was 88.95% (standard deviation 10.03) and mean specificity was 89.50% (standard deviation 12.21). Conclusion: The current literature reveals high sensitivity and specificity in the use of ultrasonography in scaphoid fracture diagnosis. However, multiple factors including technical differences in ultrasound machines and probes, small sample sizes and variability of subsequent confirmatory tests have created a challenge in determining the ultimate reliability of ultrasonography in the diagnosis of occult scaphoid fractures. Considering these factors and limitations, large-sample and high-quality clinical trials are needed to adequately assess its reliability for this purpose. One stop clinics, in the authors’ opinion, would be an ideal setting for its introduction as well as for future trials.

Diagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review update

“…Moreover, physicians must keep in mind that BS is more invasive than the other modalities. Previous reviews by Kwee et al and Ali et al concluded that US can diagnose occult scaphoid fracture with a fairly high degree of accuracy and Kwee et al stated that US may be used when CT and MRI are not readily available [37,38]. Nonetheless, one needs to keep in mind that, although scaphoid fractures are the most frequently injured carpal bones, the consequences of fractures of other carpal bones should not be underestimated.…”

“…Nonetheless, one needs to keep in mind that, although scaphoid fractures are the most frequently injured carpal bones, the consequences of fractures of other carpal bones should not be underestimated. All previously available systematic reviews only examined diagnostic tests for scaphoid fractures [32][33][34][35][36][37][38][39], while in practice it is often not quite clear during the diagnostic process which hand or wrist anatomical structure or tissue (soft tissue or bone) is affected.…”

“…Currently, there are several systematic reviews available on the diagnostic accuracy of tests for the diagnosis of hand and wrist fractures, as presented in Table 1 [32][33][34][35][36][37][38][39]. Of these, only the review by Carpenter et al used 'history' as a keyword in their search terms, but they could not find studies assessing the diagnostic accuracy of history for scaphoid fractures [32].…”

“…Of these, only the review by Carpenter et al used 'history' as a keyword in their search terms, but they could not find studies assessing the diagnostic accuracy of history for scaphoid fractures [32]. All the available systematic reviews only examined diagnostic tests for scaphoid fractures [32][33][34][35][36][37][38][39], while in practice it is often not quite clear during the diagnostic process which hand or wrist anatomical structure or tissue (soft tissue or bone) is affected. Moreover, these reviews focused predominantly on imaging as a diagnostic tool, while in clinical practice a diagnosis is mainly made on history taking and physical examination.…”

Klinische und bildgebende Diagnostik der Kahnbeinfraktur und -pseudarthrose

“…Um eine Sensitivität von jeweils 86 und 89 % sowie eine Spezifität von 84-90 % anhand der vorhandenen Literatur berechnen [23,24].…”