New clinical test for fracture of the scaphoid

The authors noted that in patients with scaphoid fractures pronation of the affected wrist followed by ulnar deviation produces pain in the anatomic snuff box that is not present in those without a scaphoid fracture. They therefore evaluated this test prospectively in 73 patients. The test gave a 52% positive predictive value and a 100% negative predictive value. They recommend that the test may be used with confidence in the emergency department to exclude a scaphoid fracture in patients with clinical features suggesting scaphoid injury but a normal x-ray film. Use of this test would reduce the number of patients whose wrists are needlessly immobilized in a scaphoid cast.