Table 3 Characteristics of the Eligible Studies (N = 35)
Author(s) | Participants | Design | Department of patient presentation (Country) | Fracture | Index test | Reference test |
|---|---|---|---|---|---|---|
SCAPHOID AND OTHER CARPAL BONES FRACTURES | ||||||
 Adey (2007) [43] | 30 | Retrospective | Not described (USA) | Scaphoid | CT | Radiographs 6 weeks after injury |
 Annamalai (2003) [44] | 50 | Retrospective | Not described (Scotland) | Scaphoid | Radiology (scaphoid and pronator fat stripe) | MRI 0,2 T (12-72 h) |
 Behzadi (2015) [45] | 124 | Retrospective | Emergency department (Germany) | Scaphoid | Radiographs (anterior-posterior, lateral and oblique projections) | MDCT (within 10 days) |
 Beeres (2007) [46] | 50 | Prospective | Emergency department (Netherlands) | Scaphoid and other carpal bones | Bone scintigraphy (3–7 days after injury) | Clinical outcome: physical examination at fixed intervals No fracture, with a normal physical examination at 2 or 6 weeks, BS was considered correct. However, if there were clinical signs of a fracture after 2 and 6 weeks, BS was considered false negative. Another fracture in the carpal region and physical examination after 2 weeks (during change of cast) matched with such a fracture, BS was considered correct. But, when physical examination after 2 weeks showed no signs of fracture, BS was considered false positive. A scaphoid fracture, confirmed on physical examination after 2 weeks (during change of cast), BS was considered correct. If however, neither physical examination after 2 weeks, nor consecutive physical examinations showed evidence of a scaphoid fracture, there was no scaphoid fracture. BS was then considered false positive. |
 Beeres (2008) [47] | 100 | Prospective | Emergency department (Netherlands) | Scaphoid | MRI 1.5 T (< 24 h) and Bone scintigraphy (between 3 and 5 days) | Absence or presence of a fracture on both MRI and bone scintigraphy, or in the case of discrepancy, clinical and/or radiological evidence of a fracture. |
 Bergh (2014) [48] | 154 | Prospective | Emergency department, outpatient clinic (Norway) | Scaphoid | Clinical Scaphoid Score (CSS): tenderness in the anatomical snuffbox with the wrist in ulnar deviation (3 points) + tenderness over the scaphoid tubercle (2 points) + pain upon longitudinal compression of the thumb (1 point) | MRI 1.5 T |
 Breederveld (2004) [49] | 29 | Prospective | Emergency department (Netherlands) | Scaphoid | BS (three-fase) and CT | Clinical follow-up (including CT and Bone scintigraphy) |
 Cruickshank (2007) [50] | 47 | Prospective | Teaching emergency department (Australia) | Scaphoid and other carpal bones | CT (same or next day) | The diagnosis on Day 10 with clinical examination and X-rays, with MRI performed in patients with persistent tenderness but normal X-rays. |
 Fusetti (2005) [51] | 24 | Prospective | Not described (Switzerland) | Scaphoid | HSR-S (< 24 h of the clinical examination) | CT (immediately after HSR-S performed) |
 Gabler (2001) [52] | 121 | Prospective | Department of traumatology: fracture clinics (Austria) | Scaphoid | Repeated clinical examination (tenderness over the anatomical snuff box or the carpus as well as a positive scaphoid compression test) and radiological examinations (scaphoid views) | MRI 1.0 T |
 Herneth (2001) [53] | 15 | Prospective | Not described (Austria) | Scaphoid | Clinical examination, radiography and High-spatial resolution ultrasonography | MRI 1,0 T (< 72 h) |
 Ilica (2011) [54] | 54 | Prospective | Emergency department (Turkey) | Scaphoid | MDCT | MRI 1.5 T |
 Kumar (2005) [55] | 22 | Prospective | Collaboration between the Department of Emergency Medicine and Medical Imaging (New Zealand) | Scaphoid | MRI 1.5 T (< 24 h) | MRI in those without fracture at MRI < 24 h or no clinical signs of fracture |
 Mallee (2011) [56] | 34 | Prospective | Initially emergency physicians and in follow-up by the Orthopedic department and/or Trauma surgery department, depending on who was on call. (Netherlands) | Scaphoid | CT and MRI 1.0 T (within 10 days) | Radiographs, after 6 weeks follow-up |
 Mallee (2016) [57] | 34 | Prospective | Initially emergency physicians and in follow-up by the Orthopedic department and/or Trauma surgery department, depending on who was on call. (Netherlands) | Scaphoid | 6-weeks radiographs in JPEG- and DICOM- view | CT, MRI, or CT and MRI |
 Mallee (2014) [58] | 34 | Prospective | Initially emergency physicians and in follow-up by the Orthopedic department and/or Trauma surgery department, depending on who was on call. (Netherlands) | Scaphoid | CT-scaphoid: reformations in planes defined by the long axis of the scaphoid. CT-wrist: reformations made in the anatomic planes of the wrist. CT performed within 10 days. | Radiographs in four standard scaphoid views after 6 weeks follow-up. |
 Memarsadeghi (2006) [59] | 29 | Prospective | Not described (Austria) | Scaphoid | MDCT and MRI 1,0 T | Radiographs obtained 6 weeks after trauma. View: posteroanterior with the wrist in neutral position, lateral, semipronated oblique scaphoid, and radial oblique scaphoid. |
 Ottenin (2012) [60] | 100 | Retrospective | Radiology department of the emergency unit (France) | Scaphoid and other carpal bones | Tomosynthesis (frontal and lateral), MDCT (within 7 days) and radiographs (posteroanterior view, lateral view, anteroposterior oblique view, scaphoid view with ulnar deviation, and posteroanterior view with clenched fist) | The reference standard for each case was determined after completion of all examinations; analysis of MRI (n = 13; performed in cases of doubt after completion of diagnostic standard radiography, tomosynthesis, and CT); and follow-up information obtained by physical examination or, in case of no clinical follow-up, by telephone recalls. |
 Platon (2011) [61] | 62 | Prospective | Emergency department (Switzerland) | Scaphoid | US within 3 days (presence of a cortical interruption of the scaphoid along with a radio-carpal or scaphotrapezium-trapezoid effusion) | CT (immediately after US) |
 Rhemrev (2010) [62] | 100 | Prospective | Emergency department (Netherlands) | Scaphoid | MDCT (< 24 h) and Bone scintigraphy (3–5 days) | Final diagnosis after final discharge, according to the following standard: If CT and bone scintigraphy showed a fracture, the final diagnosis was fracture. If CT and bone scintigraphy showed no fracture, the final diagnosis was no fracture. In case of discrepancy between CT and bone scintigraphy, both radiographic (6 weeks after injury) and physical reevaluation during follow-up were used to make a final diagnosis. In case of radiographic evidence of a scaphoid fracture 6 weeks after injury, the final diagnosis was fracture. In case of no radiographic evidence of a scaphoid fracture 6 weeks after injury but there were persistent clinical signs of a scaphoid fracture after 2 weeks, the final diagnosis was fracture. If there was no radiographic evidence of a scaphoid fracture 6 weeks after injury and there were no longer clinical signs of a scaphoid fractures throughout follow-up, the final diagnosis was no fracture. |
 Rhemrev (2010) [63] | 78 | Prospective | Emergency department (Netherlands) | Scaphoid | Three clinical exams: 1) inspection of the snuffbox for the presence of ecchymosis or edema, 2) flexion and extension of the wrist, 3) Supination and pronation strength, 4) Grip strength. | MRI 1,5 T, bone scintigraphy, radiography and physical re-evaluation during 6 weeks clinical follow-up. |
 Steenvoorde (2006) [64] | 31 | Not described | Emergency department (Netherlands): request for radiograph of the scaphoid by general practitioners were excluded | Scaphoid and other carpal bones | Five or more positive clinical tests out of seven tests: 1) loss of concavity of the anatomic snuff box, 2) snuffbox tenderness, 3) the clamp sign, 4) palmar tenderness of the scaphoid, 5) axial compression of the thumb along its longitudinal axis, 6) site of pain on resisted supination, 7) site of pain on ulnar deviation. | Clinical follow-up |
 Yildirim (2013) [65] | 63 | Prospective | Emergency department (Turkey) | Scaphoid | BUS (presence of a cortical interruption of the scaphoid along with a radiocarpal or scaphotrapezium trapezoid effusion) | MRI (< 24 h) |
 de Zwart (2016) [66] | 33 | Prospective | Emergency department (Netherlands) | Scaphoid | MRI (< 72 h), CT(< 72 h) and Bone Scintigraphy (between 3 and 5 days) | If MRI, CT and BS all showed a fracture, the final diagnosis was: fracture. If MRI, CT and BS all showed no fracture, the final diagnosis was: no fracture. In case of discrepancy between MRI, CT and BS, the final diagnosis was established based on specific clinical signs of a fracture after 6 weeks (tender anatomic snuffbox and pain in the snuffbox when applying axial pressure on the first or second digit) combined with the radiographic evidence of a fracture after 6 weeks. If these signs were absent and no radiographic evidence, the final diagnosis was: no fracture. |
 Sharifi (2015) [67] | 175 | Prospective | Emergency department (Iran) | Scaphoid fractures | VAS pain score (anatomical snuff box tenderness) | MRI |
 Brink (2014) [68] | 98 | Prospective | Department of Radiology (Netherlands) | Fractures carpus and metacarpal | CT or radiography | Clinical follow-up |
 Neubauer (2018) [69] | 102 | Retrospective | Orthopedics and Trauma/Hand Surgery (Germany) | Scaphoid fractures | CBCT or radiography | Clinical follow-up (including images) |
 Borel (2017) [70] | 49 | Prospective | Orthopedics and Trauma Surgery (France) | Scaphoid or wrist fractures | CBCT | MRI |
SCAPHOID, OTHER CARPAL AND METACARPAL BONES FRACTURES | ||||||
 Balci (2015) [71] | 455 | Retrospective | Emergency department (Turkey) | Carpal and metacarpal | Radiographs | MDCT |
 Jorgsholm (2013) [72] | 296 | Prospective | Emergency department (Sweden) | Scaphoid, other carpal and metacarpal bones | Radiographs (dorsovolar and lateral projections with an additional 4 views of the scaphoid.) and CT | MRI 0.23 T (within 3 days) |
 Nikken (2005) [73] | 87 | Prospective | Radiology department referred by traumatologist, orthopedic surgeon or emergency physician (Netherlands) | Scaphoid and other carpal bones. Metacarpal bones II–IV | Anatomic snuffbox tenderness, radiographs (posteroanterior and lateral projection) and MRI 0,2 T (short procedure) | Additional treatment |
CARPAL AND METACARPAL BONES AND PHALANGEAL FRACTURES | ||||||
 Javadzadeh (2014) [74] | 260 | Not described | Emergency department (Iran) | Carpal, metacarpal, and phalangeal | BUS and WBT ultrasonography | Radiographs (not described when performed) |
METACARPAL BONES AND/OR PHALANGEAL FRACTURES | ||||||
 Faccioli (2010) [75] | 57 | Prospective | Traumatology department (Italy) | Phalangeal | CBCT | MSCT |
 Kocaoglu (2016) [76] | 96 | Prospective | Emergency department (Turkey) | Metacarpal | US | Radiographs (anteroposterior and oblique) |
 Tayal (2007) [77] | 78 | Prospective | Emergency department (USA) | Metacarpal and phalangeal | US and physical examination | Radiographs and when operated, surgical findings |