Diagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review update
Abstract Background The standard diagnostic work-up for hand and wrist fractures consists of history taking, physical examination and imaging if needed, but the supporting evidence for this work-up is limited. The purpose of this study was to systematically examine the diagnostic accuracy of tests f...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-01-01
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| Series: | BMC Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12891-019-2988-z |
| _version_ | 1818419207809794048 |
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| author | Patrick Krastman Nina M. Mathijssen Sita M. A. Bierma-Zeinstra Gerald Kraan Jos Runhaar |
| author_facet | Patrick Krastman Nina M. Mathijssen Sita M. A. Bierma-Zeinstra Gerald Kraan Jos Runhaar |
| author_sort | Patrick Krastman |
| collection | DOAJ |
| description | Abstract Background The standard diagnostic work-up for hand and wrist fractures consists of history taking, physical examination and imaging if needed, but the supporting evidence for this work-up is limited. The purpose of this study was to systematically examine the diagnostic accuracy of tests for hand and wrist fractures. Methods A systematic search for relevant studies was performed. Methodological quality was assessed and sensitivity (Se), specificity (Sp), accuracy, positive predictive value (PPV) and negative predictive value (NPV) were extracted from the eligible studies. Results Of the 35 eligible studies, two described the diagnostic accuracy of history taking for hand and wrist fractures. Physical examination with or without radiological examination for diagnosing scaphoid fractures (five studies) showed Se, Sp, accuracy, PPV and NPV ranging from 15 to 100%, 13–98%, 55–73%, 14–73% and 75–100%, respectively. Physical examination with radiological examination for diagnosing other carpal bone fractures (one study) showed a Se of 100%, with the exception of the triquetrum (75%). Physical examination for diagnosing phalangeal and metacarpal fractures (one study) showed Se, Sp, accuracy, PPV and NPV ranging from 26 to 55%, 13–89%, 45–76%, 41–77% and 63–75%, respectively. Imaging modalities of scaphoid fractures showed predominantly low values for PPV and the highest values for Sp and NPV (24 studies). Magnetic Resonance Imaging (MRI), Computed Tomography (CT), Ultrasonography (US) and Bone Scintigraphy (BS) were comparable in diagnostic accuracy for diagnosing a scaphoid fracture, with an accuracy ranging from 85 to 100%, 79–100%, 49–100% and 86–97%, respectively. Imaging for metacarpal and finger fractures showed Se, Sp, accuracy, PPV and NPV ranging from 73 to 100%, 78–100%, 70–100%, 79–100% and 70–100%, respectively. Conclusions Only two studies were found on the diagnostic accuracy of history taking for hand and wrist fractures in the current review. Physical examination was of moderate use for diagnosing a scaphoid fracture and of limited use for diagnosing phalangeal, metacarpal and remaining carpal fractures. MRI, CT and BS were found to be moderately accurate for the definitive diagnosis of clinically suspected carpal fractures. |
| first_indexed | 2024-12-14T12:34:54Z |
| format | Article |
| id | doaj.art-7a0acc32f74d4761b6451a3ea5aa42db |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-12-14T12:34:54Z |
| publishDate | 2020-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-7a0acc32f74d4761b6451a3ea5aa42db2022-12-21T23:01:05ZengBMCBMC Musculoskeletal Disorders1471-24742020-01-0121112410.1186/s12891-019-2988-zDiagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review updatePatrick Krastman0Nina M. Mathijssen1Sita M. A. Bierma-Zeinstra2Gerald Kraan3Jos Runhaar4Department of General Practice, Erasmus MC University Medical Center RotterdamDepartment of Orthopaedic Surgery, Reinier de Graaf GroepDepartment of Orthopaedics, Erasmus MC University Medical Center RotterdamDepartment of Orthopaedic Surgery, Reinier de Graaf GroepDepartment of General Practice, Erasmus MC University Medical Center RotterdamAbstract Background The standard diagnostic work-up for hand and wrist fractures consists of history taking, physical examination and imaging if needed, but the supporting evidence for this work-up is limited. The purpose of this study was to systematically examine the diagnostic accuracy of tests for hand and wrist fractures. Methods A systematic search for relevant studies was performed. Methodological quality was assessed and sensitivity (Se), specificity (Sp), accuracy, positive predictive value (PPV) and negative predictive value (NPV) were extracted from the eligible studies. Results Of the 35 eligible studies, two described the diagnostic accuracy of history taking for hand and wrist fractures. Physical examination with or without radiological examination for diagnosing scaphoid fractures (five studies) showed Se, Sp, accuracy, PPV and NPV ranging from 15 to 100%, 13–98%, 55–73%, 14–73% and 75–100%, respectively. Physical examination with radiological examination for diagnosing other carpal bone fractures (one study) showed a Se of 100%, with the exception of the triquetrum (75%). Physical examination for diagnosing phalangeal and metacarpal fractures (one study) showed Se, Sp, accuracy, PPV and NPV ranging from 26 to 55%, 13–89%, 45–76%, 41–77% and 63–75%, respectively. Imaging modalities of scaphoid fractures showed predominantly low values for PPV and the highest values for Sp and NPV (24 studies). Magnetic Resonance Imaging (MRI), Computed Tomography (CT), Ultrasonography (US) and Bone Scintigraphy (BS) were comparable in diagnostic accuracy for diagnosing a scaphoid fracture, with an accuracy ranging from 85 to 100%, 79–100%, 49–100% and 86–97%, respectively. Imaging for metacarpal and finger fractures showed Se, Sp, accuracy, PPV and NPV ranging from 73 to 100%, 78–100%, 70–100%, 79–100% and 70–100%, respectively. Conclusions Only two studies were found on the diagnostic accuracy of history taking for hand and wrist fractures in the current review. Physical examination was of moderate use for diagnosing a scaphoid fracture and of limited use for diagnosing phalangeal, metacarpal and remaining carpal fractures. MRI, CT and BS were found to be moderately accurate for the definitive diagnosis of clinically suspected carpal fractures.https://doi.org/10.1186/s12891-019-2988-zDiagnostic testsFingerFractureHandWrist |
| spellingShingle | Patrick Krastman Nina M. Mathijssen Sita M. A. Bierma-Zeinstra Gerald Kraan Jos Runhaar Diagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review update BMC Musculoskeletal Disorders Diagnostic tests Finger Fracture Hand Wrist |
| title | Diagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review update |
| title_full | Diagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review update |
| title_fullStr | Diagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review update |
| title_full_unstemmed | Diagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review update |
| title_short | Diagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review update |
| title_sort | diagnostic accuracy of history taking physical examination and imaging for phalangeal metacarpal and carpal fractures a systematic review update |
| topic | Diagnostic tests Finger Fracture Hand Wrist |
| url | https://doi.org/10.1186/s12891-019-2988-z |
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