Is physical examination as effective as magnetic resonance imaging in the diagnosis of suspected pediatric scaphoid fractures?

OBJECTIVE: The aim of this study was to evaluate whether careful physical examination is as effective in diagnosis as magnetic resonance imaging (MRI) in pediatric patients with suspected scaphoid fractures and whether radiography is sufficient in the follow-up of these patients.
METHODS: This prospective study included patients with tenderness of the anatomic snuffbox on physical examination and no fracture on radiography between 2015 and 2019, and the data were evaluated retrospectively. A short-arm thumb spica casting was applied for an initial diagnosis of suspected scaphoid fracture. MRI was performed within 1 week after initial trauma. Physical examination and X-rays at 2-week intervals were applied during the follow-up period. The functional outcomes were evaluated using the Modified Mayo Wrist score.
RESULTS: A total of 92 patients (28 girls and 64 boys; mean age: 12.32±2.22 years) were diagnosed with suspected scaphoid fracture on physical examination and MRI was performed. The MRI confirmed the suspected scaphoid fracture at the rate of 77.2% (n=71). The sensitivity obtained for the radiograph was 14.08%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 25.61%. The mean Modified Mayo Wrist score was 92.43±2.64 (range, 85–98).
CONCLUSION: Detection of tenderness on the anatomic snuffbox without determination of fracture radiographically should be evaluated and treated in favor of a scaphoid fracture. These fractures are mostly treated successfully with conservative treatment

Þüpheli Pediatrik Skafoid Kýrýklarýnýn Tanýsýnda Fizik Muayene MR Görüntüleme Kadar Etkili midir?

Amaç
Bu çalýþmanýn amacý, skafoid kýrýðý þüphesi olan çocuk hastalarda dikkatli fizik muayenenin tanýda manyetik rezonans görüntüleme (MRG) kadar etkili olup olmadýðýný ve bu hastalarýn izleminde radyografinin yeterli olup olmadýðýný deðerlendirmektir.
Yöntemler
Bu retrospektif çalýþmaya 2015-2019 yýllarý arasýnda anatomik enfiye kutusu hassasiyeti olan ve radyografide kýrýðý olmayan hastalar dahil edildi. Þüpheli skafoid kýrýðý tanýsý olan hastalara kýsa kol baþ parmak destekli alçý uygulandý. Hastalara ilk tanýdan 1 hafta sonra MRG çekildi. Hastalarýn takibinde 2 haftalýk aralýklarla fizik muayene ve MRG de fraktür olanlara da röntgen çekildi. Hastalarýn el bileði fonksiyonel sonuçlarý Modifiye Mayo Bilek skoru kullanýlarak deðerlendirildi.
Sonuçlar
Fizik muayenede skafoid kýrýðý þüphesi olan toplam 92 hastaya (28 kýz, 64 erkek; ort. Yaþ: 12.32 ± 2.22 yýl) MRG çekildi. MRG þüpheli skafoid kýrýðýný %77,2 (n = 71) oranýnda doðruladýðý görüldü. Radyografi için elde edilen duyarlýlýk %14.08, özgüllük %100, pozitif öngörü deðeri %100 ve negatif öngörü deðeri % 25.61 idi. Hastalarýn ortalama Modifiye Mayo Bilek skoru 92.43 ± 2.64 (aralýk, 85-98) idi.
Sonuç
Anatomik enfiye kutusunda hassasiyeti olan çocuk hastalar radyografik olarak kýrýðýn belirlenmesine gerek kalmadan deðerlendirilmeli ve skafoid kýrýðý lehine tedavi edilmelidir. Bu kýrýklar çoðunlukla konservatif tedavi ile baþarýlý bir þekilde tedavi edilir. (NCI-2021-3-31/R1)