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Occult fractures of the scaphoid: the role of ultrasonography in the emergency department

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Abstract

Objective

To evaluate ultrasonography (US) performed by an emergency radiologist in patients with clinical suspicion of scaphoid fracture and normal radiographs.

Materials and methods

Sixty-two consecutive adult patients admitted to our emergency department with clinical suspicion of scaphoid fracture and normal radiographs underwent US examination of the scaphoid prior to wrist computed tomography (CT), within 3 days following wrist trauma. US examination was performed by a board-certified emergency radiologist, non-specialized in musculoskeletal imaging, using the linear probe (5-13 MHz) of the standard sonographic equipment of the emergency department. The radiologist evaluate for the presence of a cortical interruption of the scaphoid along with a radio-carpal or scapho-trapezium-trapezoid effusion. A CT of the wrist (reference standard) was performed in every patient, immediately after ultrasonography. Fractures were classified into two groups according to their potential for complication: group 1 (high potential, proximal or waist), group 2 (low-potential, distal or tubercle).

Results

A scaphoid fracture was demonstrated by CT in 13 (21%) patients: eight (62%) of them belonged to group 1 (three in the proximal pole, five in the waist), five (38%) to group 2 (three in the distal part, two in the tubercle). US was 92% sensitive (12/13) in demonstrating a scaphoid fracture. It was 100% sensitive (8/8) in demonstrating a fracture with a high potential of complication (group 1).

Conclusions

Our data show that, in emergency settings, US can be used for the triage to CT in patients with clinical suspicion of scaphoid fracture and normal radiographs.

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References

  1. Haisman JM, Rohde RS, Weiland AJ. Acute fractures of the scaphoid. J Bone Joint Surg Am. 2006;88:2750–8.

    PubMed  Google Scholar 

  2. 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;178:1239–45.

    PubMed  Google Scholar 

  3. Schubert HE. Scaphoid fracture. Review of diagnostic tests and treatment. Can Fam Physician. 2000;46:1825–32.

    PubMed  CAS  Google Scholar 

  4. Groves AM, Kayani I, Syed R, Hutton BF, Bearcroft PP, Dixon AK, et al. An international survey of hospital practice in the imaging of acute scaphoid trauma. AJR Am J Roentgenol. 2006;187:1453–6.

    Article  PubMed  Google Scholar 

  5. Ring D, Jupiter JB, Herndon JH. Acute fractures of the scaphoid. J Am Acad Orthop Surg. 2000;8:225–31.

    PubMed  CAS  Google Scholar 

  6. Adey L, Souer JS, Lozano-Calderon S, Palmer W, Lee SG, Ring D. Computed tomography of suspected scaphoid fractures. J Hand Surg Am. 2007;32:61–6.

    Article  PubMed  Google Scholar 

  7. Memarsadeghi M, Breitenseher MJ, Schaefer-Prokop C, Weber M, Aldrian S, Gabler C, et al. Occult scaphoid fractures: comparison of multidetector CT and MR imaging–initial experience. Radiology. 2006;240:169–76.

    Article  PubMed  Google Scholar 

  8. Ring D, Lozano-Calderon S. Imaging for suspected scaphoid fracture. J Hand Surg Am. 2008;33:954–7.

    Article  PubMed  Google Scholar 

  9. 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;59:677–81.

    PubMed  CAS  Google Scholar 

  10. 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;220:231–5.

    PubMed  CAS  Google Scholar 

  11. Jacobson JA. Fundamentals of musculoskeletal ultrasound. Philadelphia: Saunders Elsevier; 2007. p. 133–77.

    Google Scholar 

  12. Jelbert A, Vaidya S, Fotiadis N. Imaging and staging of haemophilic arthropathy. Clin Radiol. 2009;64:1119–28.

    Article  PubMed  CAS  Google Scholar 

  13. Zukotynski K, Jarrin J, Babyn PS, Carcao M, Pazmino-Canizares J, Stain A, et al. Sonography for assessment of haemophilic arthropathy in children: a systematic protocol. Haemophilia. 2007;13:293–304.

    Article  PubMed  CAS  Google Scholar 

  14. Kaewlai R, Avery LL, Asrani AV, Abujudeh HH, Sacknoff R, Novelline RA. Multidetector CT of carpal injuries: anatomy, fractures, and fracture-dislocations. Radiographics. 2008;28:1771–84.

    Article  PubMed  Google Scholar 

  15. Senall JA, Failla JM, Bouffard JA, van Holsbeeck M. Ultrasound for the early diagnosis of clinically suspected scaphoid fracture. J Hand Surg Am. 2004;29:400–5.

    Article  PubMed  Google Scholar 

  16. Munk B, Bolvig L, Kroner K, Christiansen T, Borris L, Boe S. Ultrasound for diagnosis of scaphoid fractures. J Hand Surg Br. 2000;25:369–71.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, University Hospital of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland

    Alexandra Platon, Pierre-Alexandre Poletti & Christoph D. Becker

  2. Hand Surgery Unit, Department of Orthopaedics and Traumatology, University Hospital of Geneva, Geneva, Switzerland

    Jan Van Aaken, Dominique Della Santa & Jean-Yves Beaulieu

  3. Hand Surgery Unit, Department of Orthopaedics and Traumatology, Ospedale San Giovanni, Bellinzona, Switzerland

    Cesare Fusetti

Authors
  1. Alexandra Platon
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  2. Pierre-Alexandre Poletti
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  3. Jan Van Aaken
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  4. Cesare Fusetti
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  5. Dominique Della Santa
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  6. Jean-Yves Beaulieu
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  7. Christoph D. Becker
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Correspondence to Alexandra Platon.

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Platon, A., Poletti, PA., Van Aaken, J. et al. Occult fractures of the scaphoid: the role of ultrasonography in the emergency department. Skeletal Radiol 40, 869–875 (2011). https://doi.org/10.1007/s00256-010-1086-y

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  • DOI: https://doi.org/10.1007/s00256-010-1086-y

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