Comparing the Role of Physical Examination and Radiography in Diagnosis of Scaphoid Fracture; Superiority or Collaboration?

Background: Scaphoid bone fracture is the most common fracture of the wrist. The most important point is its early diagnosis so as to prevent consequent complications. Physical examination and radiography are two main ways of diagnosis. Objectives: So we aimed to evaluate the accuracy of clinical and radiographic examinations in the diagnosis of scaphoid fracture. Patients and Methods: In this prospective study, 48 patients suspicious for scaphoid fracture attending to emergency ward of our hospital were enrolled. Scaphoid tubercle tenderness test, compression and anatomical snuffbox tenderness tests were done and radiographies of four views of hand (anterior-posterior, lateral, ulnar oblique and radial oblique) were taken from patients. In case of positive finding in one or more clinical tests and normal radiographies, patient’s wrist was immobilized by cast for two weeks. Then a second radiography was taken and the results of clinical examinations and primary radiography were compared with second radiography in order to determine sensitivity and specificity of radiographies and clinical assessments. Results: Eventually 48 patients including 31 (64.6%) males and 17 (35.4%) females with a mean age of 38 years old underwent analysis. Scaphoid tubercle tenderness test had the maximum sensitivity (95.24%), specificity (74.07%) and diagnostic accuracy (56.25%) as well as the least false positive cases (25.92%). Anterior-posterior (AP) radiography had the maximum sensitivity (47.61%), specificity (100%) and diagnostic accuracy (20.83%) as well as the least false negative cases (28.94%). Conclusions: Scaphoid tubercle tenderness tests in association with x-ray radiographies, especially anterior-posterior view, are the most useful tests for diagnosis of scaphoid fractures.