![]() ![]() The criteria for a ‘positive’ scan and the gold standards applied were variable and not always clearly defined. The ultrasound scans have been performed by radiologists with no attempt to assess inter or intra-observer variability, and it is impossible to extrapolate how well it could be applied by an emergency physician with less training. An investigation that could reliably rule out an occult scaphoid fracture at the time of presentation could save the patient the inconvenience of having an immobilised wrist and save the health services the time and cost of reviewing the patient and arranging further investigations.Īll of the included studies are small and subject to some limitations. At this time, it is hoped that decalcification at the fracture site may make any fracture more apparent however, in the presence of clinical suspicion a negative x-ray at this point is still insufficient to rule out a fracture and treatment must continue while further investigation is arranged. Common practice is to treat the patient with a cast and then reassess and repeat the x-ray 10–14 days following the injury. The risks of non-union and avascular necrosis in this bone are such that any clinical suspicion of fracture requires appropriate immobilisation even if the x-rays appear normal. US performed by radiologistĪs long as people keep falling over it is reasonable to assume that suspected scaphoid fractures will remain a very frequent cause of attendance at emergency departments. Patients assessed at review clinic rather than on presentation. For cortical disruption on US sensitivity was 100% and specificity 95% For moderate suspicion on US sensitivity was 100% and specificity 79%. Five of nine of fractures visible on initial x-rayĢ4 Consecutive patients with clinical suspicion of scaphoid fracture and normal xrays attending a hand clinicįive patients had fracture on CT scan. Sensitivity of US was 78% with a specificity of 100% Positive MRI scan at time of presentation was considered gold standard Different radiologists performed the US, no attempt made at assessing interobserver reliabilityġ5 patients with clinical signs of scaphoid fracture attending an orthopaedic clinic Sensitivity of US was 78%, specificity was 89% X-rays performed on attendance, 2/52 after injury and then monthly as long there was clinical suspicion Inclusion criteria did not include anatomical snuffbox tendernessġ8 Patients attending an emergency department with traumatic wrist injury, a high clinical suspicion of fracture and normal x-ray ![]() Six patients showed cortical disruption on US scan, five of these patients had a fracture on repeat x-ray. Positive x-ray or on the basis of clinical suspicion patients could have MRI, CT scan or bone scan Observational unblinded diagnostic study. Little information provided about the criteria used for US diagnosisĥ4 patients attending x-ray department with clinical signs of scaphoid fracture and normal initial x-rays US examination had a sensitivity of 50% and specificity of 91% Relevant Paper(s) Author, date and countryĥ8 patients with unilateral wrist injury and clinical signs of scaphoid fracture attending orthopaedic clinicĪll patients had x-rays taken initially and at 10-14 daysġ0/58 Patients had a fracture diagnosed on x-ray. Twenty-one relevant articles were identified, five of which were found to address the clinical question Keyword search: (scaphoid bone OR Carpal bones OR Fractures OR wrist injuries OR un-united) AND (Ultrasonography OR Ultrasonics OR Interventional Ultrasonography OR Ultrasound OR Sonography OR High-intensity Focused OR High-intensity focussed). Mesh terms (scaphoid bone) and (ultrasonography). Medline, CINAHL, and Embase databases using Ovid interface in June 2010. You wonder if ultrasound could be used to identify an occult scaphoid fracture. He has clinical signs of a scaphoid fracture but his initial x-rays are normal. In an, can detect the presence of an ? Clinical ScenarioĪ 24-year-old man presents following a fall on an outstretched hand. ![]()
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