Ultrasound in the diagnosis of scaphoid fractures

Shenouda, Ninette; England, J P S

doi:10.1016/0266-7681(87)90053-2

Cited by 23 publications

(14 citation statements)

References 5 publications

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“…Therapeutic wavelengths often, but not consistently, elicit pain at the fracture site. [4][5][6] There were no reports of pain or discomfort while using the 10 MHz probe over the fracture site.…”

Section: Discussionmentioning

confidence: 96%

Ultrasound imaging of forearm fractures in children: a viable alternative?

Williamson

Watura²,

Cobby³

2000

Emergency Medicine Journal

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Objective-A pilot study to investigate whether ultrasonography can be reliably used to demonstrate uncomplicated greenstick and torus fractures in children. Method-Children between the ages of 2 and 14 years with a high clinical suspicion of a non-articular, undisplaced forearm fracture were included. Ultrasound imaging of the injury was performed by a consultant radiologist who gave an immediate report. Standard radiographs of the forearm were then obtained and the patient treated in the normal way. The radiograph was formally reported on at a later date. Results-26 patients were included. There was an absolute correlation between the ultrasound and radiographic findings. The procedure was well tolerated. Conclusion-Ultrasound seems eVective for detecting uncomplicated forearm fractures in children. The procedure is easy to perform and the images easy to interpret. A larger study will now be undertaken to confirm these initial findings. (J Accid Emerg Med 2000;17:22-24)

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Section: Discussionmentioning

confidence: 96%

Ultrasound imaging of forearm fractures in children: a viable alternative?

Williamson

Watura²,

Cobby³

2000

Emergency Medicine Journal

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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%

“…A "positive" US is defined as pain produced when US imaging commences. [18][19][20][21][22][23] Other physical examination maneuvers include assessment of pain in the scaphoid with ulnar or radial deviation of the wrist or with resisted supination (Data Supplement S6, available as supporting information in the online version of this paper) and pronation. 24 Two diagnostic meta-analyses have been published in the orthopedic surgery literature to evaluate advanced imaging modalities for scaphoid fracture, but none focus on history and physical examination diagnostic accuracy or ED-specific pretest probability, all necessary to facilitate Bayesian reasoning for bedside clinicians.…”

mentioning

confidence: 99%

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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“…Though its mode of action is unclear, ultrasonic energy in the therapeutic range is known to be capable of producing pain or severe tingling when applied to fractures less than 2 weeks old (Nitz & Scoville, 1980;Bedford et al, 1982;Shenouda & England, 1987). In the latter two studies, a strong but not absolute correlation was found between the presence of a recent scaphoid fracture and pain.…”

Section: Introductionmentioning

confidence: 97%

Ultrasound assessment of the suspected scaphoid fracture.

DaCruz

Taylor

Savage

et al. 1988

Emergency Medicine Journal

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SUMMARYA prospective study of 111 patients thought to have sustained a recent scaphoid fracture on clinical grounds but who were radiologically negative was undertaken over a period of 7 months. All such patients were subjected to ultrasound scanning within a week of their injury under double blind conditions. All patients were re-X-rayed 2-3 weeks after their injury. The authors' results suggest that ultrasonic diagnosis of the possibly fractured scaphoid is unreliable.

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Ultrasound in the diagnosis of scaphoid fractures

Cited by 23 publications

References 5 publications

Ultrasound imaging of forearm fractures in children: a viable alternative?

Ultrasound imaging of forearm fractures in children: a viable alternative?

Adult Scaphoid Fracture

Ultrasound assessment of the suspected scaphoid fracture.

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