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Table 3 Characteristics of the Eligible Studies (N = 35)

From: Diagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review update

Author(s)ParticipantsDesignDepartment of patient presentation (Country)FractureIndex testReference test
SCAPHOID AND OTHER CARPAL BONES FRACTURES
 Adey (2007) [43]30RetrospectiveNot described (USA)ScaphoidCTRadiographs 6 weeks after injury
 Annamalai (2003) [44]50RetrospectiveNot described (Scotland)ScaphoidRadiology (scaphoid and pronator fat stripe)MRI 0,2 T (12-72 h)
 Behzadi (2015) [45]124RetrospectiveEmergency department (Germany)ScaphoidRadiographs (anterior-posterior, lateral and oblique projections)MDCT (within 10 days)
 Beeres (2007) [46]50ProspectiveEmergency department (Netherlands)Scaphoid and other carpal bonesBone 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]100ProspectiveEmergency department (Netherlands)ScaphoidMRI 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]154ProspectiveEmergency department, outpatient clinic (Norway)ScaphoidClinical 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]29ProspectiveEmergency department (Netherlands)ScaphoidBS (three-fase) and CTClinical follow-up (including CT and Bone scintigraphy)
 Cruickshank (2007) [50]47ProspectiveTeaching emergency department (Australia)Scaphoid and other carpal bonesCT (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]24ProspectiveNot described (Switzerland)ScaphoidHSR-S (< 24 h of the clinical examination)CT (immediately after HSR-S performed)
 Gabler (2001) [52]121ProspectiveDepartment of traumatology: fracture clinics (Austria)ScaphoidRepeated 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]15ProspectiveNot described (Austria)ScaphoidClinical examination, radiography and High-spatial resolution ultrasonographyMRI 1,0 T (< 72 h)
 Ilica (2011) [54]54ProspectiveEmergency department (Turkey)ScaphoidMDCTMRI 1.5 T
 Kumar (2005) [55]22ProspectiveCollaboration between the Department of Emergency Medicine and Medical Imaging (New Zealand)ScaphoidMRI 1.5 T (< 24 h)MRI in those without fracture at MRI < 24 h or no clinical signs of fracture
 Mallee (2011) [56]34ProspectiveInitially emergency physicians and in follow-up by the Orthopedic department and/or Trauma surgery department, depending on who was on call. (Netherlands)ScaphoidCT and MRI 1.0 T (within 10 days)Radiographs, after 6 weeks follow-up
 Mallee (2016) [57]34ProspectiveInitially emergency physicians and in follow-up by the Orthopedic department and/or Trauma surgery department, depending on who was on call. (Netherlands)Scaphoid6-weeks radiographs in JPEG- and DICOM- viewCT, MRI, or CT and MRI
 Mallee (2014) [58]34ProspectiveInitially emergency physicians and in follow-up by the Orthopedic department and/or Trauma surgery department, depending on who was on call. (Netherlands)ScaphoidCT-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]29ProspectiveNot described (Austria)ScaphoidMDCT and MRI 1,0 TRadiographs obtained 6 weeks after trauma. View: posteroanterior with the wrist in neutral position, lateral, semipronated oblique scaphoid, and radial oblique scaphoid.
 Ottenin (2012) [60]100RetrospectiveRadiology department of the emergency unit (France)Scaphoid and other carpal bonesTomosynthesis (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]62ProspectiveEmergency department (Switzerland)ScaphoidUS 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]100ProspectiveEmergency department (Netherlands)ScaphoidMDCT (< 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]78ProspectiveEmergency department (Netherlands)ScaphoidThree 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]31Not describedEmergency department (Netherlands): request for radiograph of the scaphoid by general practitioners were excludedScaphoid and other carpal bonesFive 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]63ProspectiveEmergency department (Turkey)ScaphoidBUS (presence of a cortical interruption of the scaphoid along with a radiocarpal or scaphotrapezium trapezoid effusion)MRI (< 24 h)
 de Zwart (2016) [66]33ProspectiveEmergency department (Netherlands)ScaphoidMRI (< 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]175ProspectiveEmergency department (Iran)Scaphoid fracturesVAS pain score (anatomical snuff box tenderness)MRI
 Brink (2014) [68]98ProspectiveDepartment of Radiology (Netherlands)Fractures carpus and metacarpalCT or radiographyClinical follow-up
 Neubauer (2018) [69]102RetrospectiveOrthopedics and Trauma/Hand Surgery (Germany)Scaphoid fracturesCBCT or radiographyClinical follow-up (including images)
 Borel (2017) [70]49ProspectiveOrthopedics and Trauma Surgery (France)Scaphoid or wrist fracturesCBCTMRI
SCAPHOID, OTHER CARPAL AND METACARPAL BONES FRACTURES
 Balci (2015) [71]455RetrospectiveEmergency department (Turkey)Carpal and metacarpalRadiographsMDCT
 Jorgsholm (2013) [72]296ProspectiveEmergency department (Sweden)Scaphoid, other carpal and metacarpal bonesRadiographs (dorsovolar and lateral projections with an additional 4 views of the scaphoid.) and CTMRI 0.23 T (within 3 days)
 Nikken (2005) [73]87ProspectiveRadiology department referred by traumatologist, orthopedic surgeon or emergency physician (Netherlands)Scaphoid and other carpal bones. Metacarpal bones II–IVAnatomic 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]260Not describedEmergency department (Iran)Carpal, metacarpal, and phalangealBUS and WBT ultrasonographyRadiographs (not described when performed)
METACARPAL BONES AND/OR PHALANGEAL FRACTURES
 Faccioli (2010) [75]57ProspectiveTraumatology department (Italy)PhalangealCBCTMSCT
 Kocaoglu (2016) [76]96ProspectiveEmergency department (Turkey)MetacarpalUSRadiographs (anteroposterior and oblique)
 Tayal (2007) [77]78ProspectiveEmergency department (USA)Metacarpal and phalangealUS and physical examinationRadiographs and when operated, surgical findings
  1. MRI Magnetic resonance imaging, CT Computed Tomography, CBCT Cone Beam Computed Tomography, MSCT Multi-slice Computed Tomography, HSR-S High Spatial Resolution sonography, BUS Bedside ultrasonography, WBT Water bath technique ROM Range of motion