Efficacy of a Physical Examination in the Diagnosis of a Scaphoid Fracture

Hwang, Seong Youn; Bae, Sung Man

Abstract

PURPOSE
A scaphoid fractures (SF), an important injury with acute pain, may not be diagnosed on the initial X-rays in the emergency department. Some authors have suggested that several clinical examinations are necessary to reliably confirm the presence of a fractured scaphoid in those patients presenting with an injury clinically suggestive of such a fracture, but without a fracture visible on the initial Xrays. we performed this prospective study to evaluate the efficacy of clinical signs believed to be useful in the diagnosis of a SF.
METHODS
We performed a 1-year prospective study on 127 patients with suspected SFs. They were examined on two separate occasions : first in the emergency department and then in the outpatient clinic of the orthopedic department 2 weeks later. Tenderness in the anatomical snuff box (ASB), tenderness over the scaphoid tubercle (ST), and pain on longitudinal compression with the thumb (LC) were evaluated.
RESULTS
At the initial examination, the ASB, the ST and LC were all 100% sensitive for detecting a SF with specificities of 40%, 49%, and 59%, respectively. These clinical signs, used in combination within the first 24 hours following injury, produced 100% sensitivity and an improvement in the specificity to 76%. Ninety-one (91) patients had one or more of positive clinical tests, with 18 of those patients having a SF visible on the initial X-ray and five having a fracture diagnosed either by repeated X-ray or CT 2 weeks after the injury.
CONCLUSION
Our results suggest that the clinical signs ASB, ST, and LC are inadequate indicators of a SF when used alone and should be combined to achieve a more accurate clinical diagnosis.