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The validity and reliability of the navicular fat stripe as a screening test for detection of navicular fractures
M Kirk1, M Orlinsky, R Goldberg
1Department of Emergency Medicine, Los Angeles County-University of Southern California Medical Center.
Study Objective:
The purpose of this study was to determine if the navicular fat stripe (NFS) is a valid and reliable screening tool in assessing potential navicular fractures.
Design:
Retrospective analysis.
Setting:
Minor trauma section of the Los Angeles County-University of Southern California Medical Center emergency department.
Type Of Participants:
Study population included patients seen for wrist injury between January 1987 and December 1988. The individuals who interpreted the radiographs included eight observers with varying degrees of radiographic experience.
Interventions:
None
Measurements And Main Results:
The positive predictive value averaged 12% or 15% depending on how we counted a straight NFS, and the negative predictive value averaged 93% or 95%, again depending on how we counted a straight NFS. A straight NFS was ten times as likely to occur among normal wrists than among those with navicular fractures. Interobserver reliability was found to be high with a Hoyt reliability coefficient of .79.
Conclusions:
An abnormal NFS is a poor predictor of a navicular fracture while both a straight and a normal NFS are good predictors of no navicular fracture. A normal NFS may allow less stringent treatment by the emergency physician. Extremes of radiographic experience were found to have no significant effect on NFS interpretation.