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Ultrasound for diagnosing radiographically occult scaphoid fracture



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


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.


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.


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.

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  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)

    Article  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  19. DaCruz DJ, Taylor RH, Savage B, Bodiwala GG. Ultrasound assessment of the suspected scaphoid fracture. Arch Emerg Med. 1988;5(2):97–100.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  20. Shenouda NA, England JP. Ultrasound in the diagnosis of scaphoid fractures. J Hand Surg Br. 1987;12(1):43–5.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  25. McInnes MD, Bossuyt PM. Pitfalls of systematic reviews and meta-analyses in imaging research. Radiology. 2015;277(1):13–21.

    Article  PubMed  Google Scholar 

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Correspondence to Robert M. Kwee.

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Kwee, R.M., Kwee, T.C. Ultrasound for diagnosing radiographically occult scaphoid fracture. Skeletal Radiol 47, 1205–1212 (2018).

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  • Ultrasound
  • Ultrasonography
  • Radiography
  • Occult
  • Scaphoid
  • Fracture