title: Ultrasound for the early diagnosis of clinically suspected scaphoid fracture.
abstract: OBJECTIVE
  To test the ability of ultrasound to diagnose clinically suspected occult scaphoid fractures.
  
  
  METHODS
  Eighteen wrists in 18 patients with an average age of 35 years (range, 10-77 years) were seen in the emergency room, each with a single traumatic wrist injury, snuffbox tenderness, swelling, and a negative wrist x-ray result. They were evaluated in this prospective, blind, controlled study by physical examination, x-ray, and high-resolution ultrasound. One hand surgeon performed the examination, and ultrasounds were read by a musculoskeletal radiologist. Patients were immobilized in a thumb spica splint and then seen in the office 1 to 14 days after the emergency room visit, at which time a repeat physical examination, wrist x-ray, and the single investigative ultrasound were done using the opposite wrist as a control. All patients were immobilized and evaluated until symptoms resolved or x-ray showed scaphoid fracture site resorption or callus, in which case they were kept immobilized until healed.
  
  
  RESULTS
  Ultrasound identified correctly 7 of 9 cases that were eventually positive for scaphoid fracture on plain x-ray. Ultrasound was read correctly as negative in 8 of 9 x-ray-negative cases; this was statistically significant. The 1 false-positive case had radioscaphoid arthrosis and radial wrist swelling. Sensitivity was 78% and specificity was 89%. The positive predictive value was 88% and negative predictive value was 80%.
  
  
  CONCLUSIONS
  We recommend that high-frequency ultrasound be used to investigate occult suspected scaphoid fractures because of its ability to allow early diagnosis and to eliminate the need for a more invasive or expensive diagnostic test in most cases.
authors.affiliation: Division of Hand Surgery, Department of Orthopaedic Surgery, Detroit, MI, USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Senall
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Failla
authors.forename: J Antonio
authors.initials: JA
authors.lastname: Bouffard
authors.forename: Marnix
authors.initials: M
authors.lastname: van Holsbeeck
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005189:False Positive Reactions; D050723:Fractures, Bone / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D007103:Immobilization; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011859:Radiography; D021361:Scaphoid Bone / Q000000981:diagnostic imaging* / Q000293:injuries*; D012680:Sensitivity and Specificity; D013165:Splints; D014463:Ultrasonography