Radiological Diagnosis of Suspected Scaphoid Fractures in Children: A Systematic Review

Background: Children presenting with suspicion of a scaphoid fracture pose a diagnostic challenge. Several imaging modalities such as plain radiograph (XR), computed tomography (CT), and magnetic resonance imaging (MRI) have been previously described. Timely and accurate diagnosis is important to avoid overtreatment, and complications, and allow for an earlier return to activity. It is unclear which imaging modality is the most diagnostically accurate for detecting scaphoid fractures in this population. Methods: A systematic review was conducted in concordance with established guidelines to elucidate the diagnostic accuracy of various imaging modalities for detecting scaphoid fractures in children. A comprehensive literature search of electronic databases was developed by experienced librarians. All steps were performed independently by 2 reviewers. Results: Eight articles were included, all evaluating plain radiographs as the index test. One study evaluated CT. XR demonstrated sensitivity values ranging from 16% to 54%, with specificity of 71% to 100%. CT had 95% sensitivity with MRI as the reference standard. The included studies were limited by poor methodologic quality and heterogeneous patient populations. Conclusions: XR demonstrates a wide range of diagnostic accuracy in diagnosing scaphoid fractures in children. CT and MRI, while promising, are limited by a lack of evidence in children. More pediatric-specific prospective studies are required to guide the choice of diagnostic imaging in children with suspected scaphoid fractures.