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

Hwang,  Seong Youn; Bae,  Sung Man

J Korean Soc Emerg Med > Volume 14(5); 2003 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2003;14(5): 653-657.

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

¹Department of Emergency Medicine, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, Korea. emergency@empal.com
²Department of Emergency Medicine, School of Medicine, Hanyang University, Seoul, Korea.

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.

Key words: Scaphoid fracture, Physical examination