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Related Concept Videos

Fractures: Bone Repair01:27

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Managing flail chest, a condition characterized by a segment of the chest wall moving independently from the rest of the thoracic cage, requires a comprehensive approach. It includes a thorough assessment of the patient's condition, a diagnostic evaluation to determine the extent of the injury, and the implementation of appropriate medical interventions tailored to the individual's needs.
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Related Experiment Video

Updated: May 1, 2026

Development of a Novel Internal Fixation Model for Rat Radial Fractures: Fracture Healing Assessment and Dorsal Root Ganglion Isolation
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Adult scaphoid fracture.

Christopher R Carpenter1, Jesse M Pines, Jeremiah D Schuur

  • 1Division of Emergency Medicine, Washington University in St. Louis, School of Medicine, St. Louis, MO.

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
|March 29, 2014
PubMed
Summary

Scaphoid fractures are common, but physical exams and initial X-rays are often insufficient for diagnosis. Magnetic resonance imaging (MRI) is the most accurate imaging test for diagnosing scaphoid fractures when initial X-rays are inconclusive.

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Area of Science:

  • Orthopedics
  • Emergency Medicine
  • Radiology

Background:

  • Scaphoid fractures are the most common carpal fractures, accounting for 70% of carpal bone injuries.
  • Initial plain X-rays are often insufficient to rule out scaphoid fractures in patients with suggestive injury mechanisms and radial-sided tenderness.
  • The diagnostic accuracy of physical examination and emergency medicine imaging for scaphoid fractures requires further clarification.

Purpose of the Study:

  • To conduct a meta-analysis of historical features, physical examination findings, and imaging studies for scaphoid fractures not visualized on initial plain X-rays in adult emergency department patients.
  • To determine the recommended imaging tests for patients with persistent concern for acute scaphoid fracture after emergency department discharge.

Main Methods:

  • A systematic literature search of PUBMED and EMBASE was performed by a medical librarian and two emergency physicians.
  • Studies were assessed for quality using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2).
  • Meta-analysis was conducted using Meta-DiSc software for studies with similar designs, focusing on sensitivity, specificity, and likelihood ratios.

Main Results:

  • 75 studies were included, with significant heterogeneity and low overall methodological quality, indicating a risk of bias.
  • Physical examination findings, except for the absence of snuffbox tenderness, lack accuracy in ruling scaphoid fractures in or out.
  • Magnetic resonance imaging (MRI) demonstrated superior accuracy compared to bone scan, computed tomography (CT), or ultrasound (US) for both ruling in and ruling out scaphoid fractures.

Conclusions:

  • History and physical examination alone are inadequate for diagnosing scaphoid fractures, with the absence of snuffbox tenderness being a notable exception.
  • MRI is the most accurate imaging modality for diagnosing scaphoid fractures in emergency department patients with negative initial X-rays.
  • CT is adequate for ruling in scaphoid fractures but insufficient for ruling them out when MRI is unavailable.