> There is increasing interest in the use of ultrasound with
> this reported in the last few days:
>
> J Hand Surg [Am]. 2004 May;29(3):400-5.
>
>
> "Ultrasound for the early diagnosis of clinically suspected
> scaphoid fracture.
>
> Senall JA, Failla JM, Bouffard JA, van Holsbeeck M.
> One hand
> surgeon performed the examination, and ultrasounds were read
> by a musculoskeletal radiologist.
> RESULTS: Ultrasound
> identified correctly 7 of 9 cases that were eventually
> positive for scaphoid fracture on plain x-ray.
> Ultrasound was read correctly as negative in 8 of 9
> x-ray-negative cases; this was statistically
> significant. The 1 false-positive case had radioscaphoid
> arthrosis and radial wrist swelling.
> Sensitivity was 78% and specificity was 89%. The positive
> predictive value was 88% and negative
> predictive value was 80%. CONCLUSIONS: We recommend that
> high-frequency ultrasound be
> used to investigate occult suspected scaphoid fractures
> because of its ability to allow early
> diagnosis and to eliminate the need for a more invasive or
> expensive diagnostic test in most cases."
Missing 2 out of 9 fractures seems quite a lot, and doesn't mean you can
avoid POP. And specificity is too low for it to be used as a "rule in". An
important issue is that these were all read by a musculoskeletal
radiologist. Great if you've got one handy. As it stands we've got a paper
showing that if you've got the resources ( and what's the chances of
getting a radiologist to do this either as a "one stop" clinic with a
clinician or by seeing the patients themselves and discharging those without
asb tenderness), then you still don't have accurate enough information to
safely change your clinical management. Or am I reading it wrong?
What I'd like to see would be a paper showing ultrasound by an EP could
reliably exclude scaphoid fracture at initial presentation (which is
unlikely give the unreliability of the technique in this small study). If
all patients could be scanned at the point of presentation (or next working
day if there was nobody with relevant ultrasound skills in the department)
and discharged if negative rather than getting a POP on in the first place,
that would be useful.
Matt Dunn
Warwick.
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