Pilot study evaluating a clinical decision tool on suspected scaphoid fractures

Area of Science:

• Orthopedic Surgery
• Emergency Medicine
• Radiology

Background:

• Scaphoid fractures are common wrist injuries often difficult to diagnose.
• Previous diagnostic accuracy for suspected scaphoid fractures can be improved.
• A scaphoid decision-protocol was previously proposed to enhance diagnosis.

Purpose of the Study:

• To evaluate the diagnostic accuracy and safety of a proposed scaphoid decision-protocol.
• To assess the protocol's impact on reducing unnecessary plaster casting and radiographic examinations.

Main Methods:

• A pilot study involving 31 patients with suspected scaphoid fractures.
• Application of a combined 7-clinical-test protocol for initial assessment.
• Analysis of fracture detection rates, including scaphoid and other fractures.

Main Results:

• 93.5% of cases with suspected scaphoid fractures had a positive test result using the combined 7 clinical tests.
• The protocol demonstrated 100% sensitivity for detecting scaphoid fractures (no false-negatives).
• 48% of patients had a scaphoid fracture, 19% had another fracture, and 32% had no fracture.

Conclusions:

• The scaphoid decision-protocol appears to be a safe method for diagnosing suspected scaphoid fractures.
• The protocol effectively reduces unnecessary plaster casting for sprained wrists.
• It also leads to a significant reduction in the need for plain radiographic examinations.