Sat., 10/15/11 Recon, UE, Wrist & Hand, Paper #89, 4:22 pm OTA-2011
Predictors of Fracture Following Suspected Injury to the Scaphoid
Andrew D. Duckworth, MSc, MRCSEd1; Geert A. Buijze, MD2; Stuart A. Aitken1;
Matthew Moran1; Alasdair Gray, MD3; Charles M. Court-Brown, MD1;
David C. Ring, MD2; Margaret M. McQueen, MD1;
1Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh,
Edinburgh, Scotland, United Kingdom;
2Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital,
Boston, Massachusetts, USA;
3Emergency Dept., Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom
Purpose: The assessment of diagnostic tests for suspected scaphoid fractures must account for the low prevalence of true fractures among suspected fractures. The development of a clinical prediction rule might improve the diagnostic performance characteristics of radiologic diagnostics tests by increasing the prevalence of true fractures. The aim of our study was to develop a clinical prediction rule using demographic and clinical factors predictive of a true scaphoid fracture.
Methods: We performed a prospective study of 260 consecutive patients with a clinically suspected or radiographically confirmed scaphoid fracture. Patients were evaluated within 72 hours of injury and at 2 and 6 weeks after injury. Demographic data, results of 7 clinical examination maneuvers, and treatment were recorded. Standard scaphoid radiographs were performed at each visit. A scaphoid fracture was defined as a fracture confirmed on radiologic imaging by 6 weeks. Statistical analysis used multivariate binary logistic regression analysis to determine significant predictors of a true scaphoid fracture.
Results: Of the 223 patients with complete data, 116 were female and the mean age was 33 years (range, 13-95 years). 62 patients (23.8%) sustained a fracture. Demographic predictors were younger age (P = 0.002), male gender (P <0.001), and sports mode of injury (P <0.001). Signs predictive of fracture within 72 hours of injury were thumb index finger pinch (P = 0.002), scaphoid tubercle tenderness (P = 0.005), and anatomic snuff box (ASB) on ulnar and radial deviation of the wrist (both P <0.001). Using multivariate regression, the independent predictors of fracture were male gender (P = 0.002), sports injury (P = 0.004), ASB pain on ulnar deviation of the wrist within 72 hours (P <0.001), and day 14 scaphoid tubercle tenderness (P <0.001). No subjects without ASB pain on ulnar deviation of the wrist within 72 hours had a fracture (n = 72). With the 4 independently significant factors positive, the risk of fracture is 91%.
Conclusion: We have developed a clinical prediction rule using demographic and clinical factors that could potentially increase the prevalence of true scaphoid fractures among suspected fractures. This could improve the diagnostic performance characteristics of radiologic diagnostics tests for the suspected scaphoid fracture.
Alphabetical Disclosure Listing (628K PDF)
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.