Rhemrev et al reported a clinical prediction rule for scaphoid fracture. This can help to decide if imaging studies are appropriate. The authors are from Medisch Centrum Haaglanden, Geire Ziekenhuizen and Massachusetts General Hospital.
Patient selection: suspected scaphoid fracture
Parameters:
(1) extension as percent of contralateral side
(2) supination strength as percent of contralateral side
(3) history of previous fracture of the involved and/or contralateral hand and/or wrist
Parameter
Finding
Points
extension
>= 50%
0
< 50%
1
supination strength
> 10%
0
<= 10%
1
history of previous fracture
no
0
yes
1
total score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 3
• The risk of a scaphoid fracture is very high if all 3 factors are present and very low if all 3 factors are absent.
History Fracture
Reduced Supination Strength
Reduced Extension
Predicted Probability
yes
yes
yes
97%
yes
yes
no
80%
yes
no
yes
75%
no
yes
yes
50%
yes
no
no
25%
no
yes
no
10%
no
no
yes
7%
no
no
no
1%
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