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Journal of Hand Surgery (British and European Volume)
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Articles

Combining the Clinical Signs Improves Diagnosis of Scaphoid Fractures

A prospective study with follow-up

J. PARVIZI
J. WAYMAN
P. KELLY
C. G. MORAN

From the Department of Orthopaedics; Newcastle General Hospital and the Department of Medical Statistics, University of Newcastle upon Tyne, UK

Correspondence: Mr C. G. Moran, Department of Fracture and Orthopaedic Surgery, University Hospital, Queen’s Medical Centre, Nottingham NG7 2UH, UK.

This is a prospective study evaluating the efficacy of four clinical signs believed to be useful in the diagnosis of scaphoid fracture. Two hundred and fifteen consecutive patients with suspected scaphoid fracture were examined on two separate occasions to evaluate tenderness in the anatomical snuff box (ASB), tenderness over the scaphoid tuberele (ST), pain on longitudinal compression of the thumb (LC) and the range of thumb movement (TM). At the initial examination ASB, ST and LC were all 100% sensitive for detecting scaphoid fracture with specificities of 9%, 30% and 48% respectively. These clinical signs used in combination, within the first 24 hours following injury, produced 100% sensitivity and an improvement in the specificity to 74%. TM had 69% sensitivity and 66% specificity. Our results suggest that these clinical signs are inadequate indicators of scaphoid fracture when used alone and should be combined to achieve a more accurate clinical diagnosis.

Journal of Hand Surgery (British and European Volume), Vol. 23, No. 3, 324-327 (1998)
DOI: 10.1016/S0266-7681(98)80050-8
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