title: Occult fractures of the scaphoid: the role of ultrasonography in the emergency department.
abstract: OBJECTIVE
  To evaluate ultrasonography (US) performed by an emergency radiologist in patients with clinical suspicion of scaphoid fracture and normal radiographs.
  
  
  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.
authors.affiliation: Department of Radiology, University Hospital of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland. alexandra.platon@hcuge.ch
authors.forename: Alexandra
authors.initials: A
authors.lastname: Platon
authors.forename: Pierre-Alexandre
authors.initials: PA
authors.lastname: Poletti
authors.forename: Jan
authors.initials: J
authors.lastname: Van Aaken
authors.forename: Cesare
authors.initials: C
authors.lastname: Fusetti
authors.forename: Dominique
authors.initials: D
authors.lastname: Della Santa
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Beaulieu
authors.forename: Christoph D
authors.initials: CD
authors.lastname: Becker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005596:Fractures, Closed / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D021361:Scaphoid Bone / Q000000981:diagnostic imaging* / Q000293:injuries*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods; D014218:Triage / Q000379:methods*; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult