BACKGROUND: This study aims to identify the physical examination tests most indicative of bone injury in patients with clinically suspected occult scaphoid fractures. METHODS: Ten physical examination manoeuvres were performed on 41 patients with a history of a fall on an outstretched hand and tenderness at the anatomical snuffbox and scaphoid tubercle without a radiographically visible fracture line. The results of wrist examination and subsequent magnetic resonance imaging (MRI) were recorded. The sensitivity, specificity, positive and negative predictive values, accuracy and likelihood ratio of the physical examinations were calculated for the patients who had bone injury confirmed by MRI. RESULTS: The distribution of MRI-confirmed conditions was as follows: 13 cases-no bone involvement; 12 cases-scaphoid fractures; 9 cases-fissures at the distal end of the radius; 6 cases-bone-bruise and 1 case-triquetral fracture. The symptoms most indicative of bone injuries were 'pain during pinching by the thumb and index fingers' and 'pain during pronation of the forearm'. CONCLUSION: The two above-mentioned manoeuvres were most indicative of bone injury in patients with clinically suspected occult scaphoid fracture. These examinations may reduce the number of unnecessary MRI examinations.
BACKGROUND: This study aims to identify the physical examination tests most indicative of bone injury in patients with clinically suspected occult scaphoid fractures. METHODS: Ten physical examination manoeuvres were performed on 41 patients with a history of a fall on an outstretched hand and tenderness at the anatomical snuffbox and scaphoid tubercle without a radiographically visible fracture line. The results of wrist examination and subsequent magnetic resonance imaging (MRI) were recorded. The sensitivity, specificity, positive and negative predictive values, accuracy and likelihood ratio of the physical examinations were calculated for the patients who had bone injury confirmed by MRI. RESULTS: The distribution of MRI-confirmed conditions was as follows: 13 cases-no bone involvement; 12 cases-scaphoid fractures; 9 cases-fissures at the distal end of the radius; 6 cases-bone-bruise and 1 case-triquetral fracture. The symptoms most indicative of bone injuries were 'pain during pinching by the thumb and index fingers' and 'pain during pronation of the forearm'. CONCLUSION: The two above-mentioned manoeuvres were most indicative of bone injury in patients with clinically suspected occult scaphoid fracture. These examinations may reduce the number of unnecessary MRI examinations.
Authors: Geert A Buijze; Wouter H Mallee; Frank J P Beeres; Timothy E Hanson; Wesley O Johnson; David Ring Journal: Clin Orthop Relat Res Date: 2011-09-30 Impact factor: 4.176