Ultrasound for Diagnosis of Scaphoid Fractures

Munk, Bo; Bolvig, Lars; Krøner, Karsten; Christiansen, T.; Borris, Lars C.; Boe, Svend

doi:10.1054/jhsb.2000.0432

Cited by 40 publications

(21 citation statements)

References 11 publications

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“…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%

“…46 All studies used US obtained and interpreted by musculoskeletal radiologists. Munk et al 83 used a mechanical annular array 7.5-MHz high-resolution scanner to image the cortex of the scaphoid, as well as a 5-to 10-MHz Doppler scanner to evaluate the displacement of the radial artery from the radial cortex of the scaphoid. Herneth et al 46 used a high-spatial-resolution 10.5-MHz linear array probe with a standoff pad placed over the wrist to increase spatial resolution.…”

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 The original studies' bibliographies were reviewed for additional references and unpublished manuscripts were located via a hand search of EM research abstracts from national meetings.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: Usmentioning

confidence: 99%

Section: Usmentioning

confidence: 99%

Adult Scaphoid Fracture

Carpenter

Pines

Schuur

et al. 2014

Academic Emergency Medicine

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“…There are a few studies evaluating ultrasound as an initial imaging modality. In one study by Munk et al, ultrasound examinations performed in an orthopedic clinic had a sensitivity of 50% and specificity of 91% when compared to radiograph performed on the day of the clinic visit and at 10-14 day follow up [19]. In an ED population, one study found pointof-care ultrasound to have a sensitivity of 78% and a specificity of 89% when compared to radiograph performed on presentation then every month thereafter as long as the patient continued to be symptomatic [20].…”

Section: Scaphoid Fracturementioning

confidence: 99%

Point-of-care ultrasound in the diagnosis of upper extremity fracture-dislocation. A pictorial essay

Saul

Lewiss

2013

Med Ultrason

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Patients commonly present with orthopedic injuries to the emergency department (ED). Although radiographs are the standard of care for evaulating these injuries, point-of-care ultrasound is being increasingly used to make the diagnosis. This modality can be useful in patients who are too clinically unstable to leave the acute care ED and in nonverbal pediatric or geriatric patients who are unable to isolate their injuries. Published case series and prospective studies highlight the emergency physician's (EP) ability to detect fractures with point-of-care ultrasound with good accuracy. The American College of Emergency Physicians ultrasound guidelines advocate fracture identification as within the EP's scope of practice. This pictorial essay reviews how to use point-of-care ultrasound to diagnose fractures and dislocations of the upper extremity.

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“…L'échographie est une technique non invasive mais elle n'a pas encore fait la preuve de sa fiabilité pour le diagnostic précoce des fractures occultes [54]. Le critère le plus spéci-fique étant la rupture de la corticale [55].…”

Section: Les Ultrasonsunclassified

Fractures récentes du scaphoïde (moins de trois semaines)

Schernberg¹

2005

Chirurgie de la Main

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Ultrasound for Diagnosis of Scaphoid Fractures

Cited by 40 publications

References 11 publications

Adult Scaphoid Fracture

Adult Scaphoid Fracture

Point-of-care ultrasound in the diagnosis of upper extremity fracture-dislocation. A pictorial essay

Fractures récentes du scaphoïde (moins de trois semaines)

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