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Skeletal Radiology

, Volume 47, Issue 9, pp 1205–1212 | Cite as

Ultrasound for diagnosing radiographically occult scaphoid fracture

  • Robert M. Kwee
  • Thomas C. Kwee
Review Article

Abstract

Objective

To systematically review the literature on the performance of ultrasound in diagnosing radiographically occult scaphoid fracture.

Methods

A systematic search was performed in the MEDLINE and Embase databases. Original studies investigating the performance of ultrasound in diagnosing radiographically occult scaphoid fracture in more than 10 patients were eligible for inclusion. Studies that included both radiographically apparent and occult scaphoid fractures (at initial radiography) were only included if independent data on radiographically occult fractures were reported. Methodological quality of the studies included was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Accuracy data were extracted. Sensitivity and specificity were pooled with a bivariate random-effects model.

Results

The inclusion criteria were met by 7 studies; total sample size comprised 314 patients. All studies, except 1, included cortical disruption of the scaphoid in their diagnostic criteria. The sensitivity and specificity of ultrasound in diagnosing radiographically occult scaphoid fracture ranged from 77.8% to 100% and from 71.4% to 100% respectively, with pooled estimates of 85.6% (95% CI: 73.9%, 92.6%) and 83.3% % (95% CI: 72.0%, 90.6%) respectively. Exclusion of two studies with a high risk of bias in any QUADAS-2 domain did not affect the pooled results.

Conclusion

Ultrasound can diagnose radiographically occult scaphoid fracture with a fairly high degree of accuracy. Because of its relatively low costs and fairly high sensitivity, ultrasound seems more cost-effective than empiric cast immobilization and may be used when CT and MRI are not readily available.

Keywords

Ultrasound Ultrasonography Radiography Occult Scaphoid Fracture 

References

  1. 1.
    Dy CJ, Baty JD, Kazmers NH, Osei DA. An epidemiologic perspective on scaphoid fracture treatment and frequency of nonunion. J Hand Surg. 2015;40:9. Supplement 1 (e7)CrossRefGoogle Scholar
  2. 2.
    Garala K, Taub NA, Dias JJ. The epidemiology of fractures of the scaphoid: impact of age, gender, deprivation and seasonality. Bone Joint J. 2016;98-B(5):654–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Duckworth AD, Jenkins PJ, Aitken SA, Clement ND, Court-Brown CM, McQueen MM. Scaphoid fracture epidemiology. J Trauma Acute Care Surg. 2012;72(2):E41–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Jenkins PJ, Slade K, Huntley JS, Robinson CM. A comparative analysis of the accuracy, diagnostic uncertainty and cost of imaging modalities in suspected scaphoid fractures. Injury. 2008;39(7):768–74.CrossRefPubMedGoogle Scholar
  5. 5.
    Mallee WH, Wang J, Poolman RW, Kloen P, Maas M, de Vet HC, Doornberg JN. Computed tomography versus magnetic resonance imaging versus bone scintigraphy for clinically suspected scaphoid fractures in patients with negative plain radiographs. Cochrane Database Syst Rev 2015;(6):CD010023.Google Scholar
  6. 6.
    Karl JW, Swart E, Strauch RJ. Diagnosis of occult scaphoid fractures: a cost-effectiveness analysis. J Bone Joint Surg Am. 2015;97(22):1860–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Joshi N, Lira A, Mehta N, Paladino L, Sinert R. Diagnostic accuracy of history, physical examination, and bedside ultrasound for diagnosis of extremity fractures in the emergency department: a systematic review. Acad Emerg Med. 2013;20(1):1–15.CrossRefPubMedGoogle Scholar
  8. 8.
    Finkenberg JG, Hoffer E, Kelly C, Zinar DM. Diagnosis of occult scaphoid fractures by intrasound vibration. J Hand Surg Am. 1993;18(1):4–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. Bossuyt PM; QUADAS-2 Group. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155(8):529–36.Google Scholar
  10. 10.
    Reitsma JB, Glas AS, Rutjes AW, Scholten RJ, Bossuyt PM, Zwinderman AH. Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol. 2005;58(10):982–90.CrossRefPubMedGoogle Scholar
  11. 11.
    Yıldırım A, Unlüer EE, Vandenberk N, Karagöz A. The role of bedside ultrasonography for occult scaphoid fractures in the emergency department. Ulus Travma Acil Cerrahi Derg. 2013;19(3):241–5.CrossRefPubMedGoogle Scholar
  12. 12.
    Platon A, Poletti PA, Van Aaken J, Fusetti C, Della Santa D, Beaulieu JY, et al. Occult fractures of the scaphoid: the role of ultrasonography in the emergency department. Skeletal Radiol. 2011;40(7):869–75.CrossRefPubMedGoogle Scholar
  13. 13.
    Fusetti C, Poletti PA, Pradel PH, Garavaglia G, Platon A, Della Santa DR, et al. Diagnosis of occult scaphoid fracture with high-spatial-resolution sonography: a prospective blind study. J Trauma. 2005;59(3):677–81.PubMedGoogle Scholar
  14. 14.
    Senall JA, Failla JM, Bouffard JA, van Holsbeeck M. Ultrasound for the early diagnosis of clinically suspected scaphoid fracture. J Hand Surg Am. 2004;29(3):400–5.CrossRefPubMedGoogle Scholar
  15. 15.
    Hauger O, Bonnefoy O, Moinard M, Bersani D, Diard F. Occult fractures of the waist of the scaphoid: early diagnosis by high-spatial-resolution sonography. AJR Am J Roentgenol. 2002;178(5):1239–45.CrossRefPubMedGoogle Scholar
  16. 16.
    Herneth AM, Siegmeth A, Bader TR, Ba-Ssalamah A, Lechner G, Metz VM, et al. Scaphoid fractures: evaluation with high-spatial-resolution US initial results. Radiology. 2001;220(1):231–5.CrossRefPubMedGoogle Scholar
  17. 17.
    Munk B, Bolvig L, Krøner K, Christiansen T, Borris L, Boe S. Ultrasound for diagnosis of scaphoid fractures. J Hand Surg Br. 2000;25(4):369–71.CrossRefPubMedGoogle Scholar
  18. 18.
    Hodgkinson DW, Nicholson DA, Stewart G, Sheridan M, Hughes P. Scaphoid fracture: a new method of assessment. Clin Radiol. 1993;48(6):398–401.CrossRefPubMedGoogle Scholar
  19. 19.
    DaCruz DJ, Taylor RH, Savage B, Bodiwala GG. Ultrasound assessment of the suspected scaphoid fracture. Arch Emerg Med. 1988;5(2):97–100.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Shenouda NA, England JP. Ultrasound in the diagnosis of scaphoid fractures. J Hand Surg Br. 1987;12(1):43–5.CrossRefPubMedGoogle Scholar
  21. 21.
    Tiel-van Buul MM, van Beek EJ, Borm JJ, Gubler FM, Broekhuizen AH, van Royen EA. The value of radiographs and bone scintigraphy in suspected scaphoid fracture. A statistical analysis. J Hand Surg Br. 1993;18(3):403–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Low G, Raby N. Can follow-up radiography for acute scaphoid fracture still be considered a valid investigation? Clin Radiol. 2005;60(10):1106–10.CrossRefPubMedGoogle Scholar
  23. 23.
    Mallee WH, Mellema JJ, Guitton TG, Goslings JC, Ring D. Doornberg JN; Science of Variation Group. 6-week radiographs unsuitable for diagnosis of suspected scaphoid fractures. Arch Orthop Trauma Surg. 2016;136(6):771–8.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Terrin N, Schmid CH, Lau J. In an empirical evaluation of the funnel plot, researchers could not visually identify publication bias. J Clin Epidemiol. 2005;58(9):894–901.CrossRefPubMedGoogle Scholar
  25. 25.
    McInnes MD, Bossuyt PM. Pitfalls of systematic reviews and meta-analyses in imaging research. Radiology. 2015;277(1):13–21.CrossRefPubMedGoogle Scholar

Copyright information

© ISS 2018

Authors and Affiliations

  1. 1.Department of RadiologyZuyderland Medical CenterHeerlenThe Netherlands
  2. 2.Department of RadiologyUniversity Medical Center GroningenGroningenThe Netherlands

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