The role of bedside ultrasonography for occult scaphoid fractures in the emergency department.

Background: Our aim is to study the accuracy of emergency medicine (EM) physician-performed, bedside ultrasonography (BUS) in patients with clinical suspicion of scaphoid fracture and normal radiographs.

Methods: From January to December 2011, an EM physician used BUS to prospectively evaluate patients presenting to the emergency department (ED) with clinical suspicion of scaphoid fracture and normal radiographs. BUS examination of the scaphoid was conducted prior to a wrist magnetic resonance imaging (MRI) scan, within 24 hours of wrist trauma. The outcome was determined by official radiology reports of the MRI. The results were compared using the chi-square test.

Results: Of the 63 enrolled patients, 12 Patients were BUS-positive. Of these, MRI results agreed with the BUS findings in 12 patients who had cortical damage of the scaphoid with hematoma. In 35 instances, hematoma with no cortical damage was detected with BUS and corroborated by MRI. A scaphoid fracture was demonstrated by MRI in two patients from this group. The sensitivity, specificity, positive predictive value, negative predictive value, and negative likelihood ratio for BUS were 85.7%, 100%, 100%, 100% and 0.14, respectively. Accuracy of BUS was not statistically different from MRI.

Conclusion: The diagnosis of scaphoid fractures is another BUS application in the ED. EM physicians should consider diagnosis of scaphoid fractures using BUS in the emergency department.