{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:41:34Z","timestamp":1787755294246,"version":"build-2784847793"},"reference-count":137,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n \n \n \u00bb Suspected scaphoid fractures are a diagnostic and therapeutic challenge despite the advances in knowledge regarding these injuries and imaging techniques. The risks and restrictions of routine immobilization as well as the restriction of activities in a young and active population must be weighed against the risks of nonunion that are associated with a missed fracture.<\/jats:p>\n <\/jats:list-item>\n \n \u00bb The prevalence of true fractures among suspected fractures is low. This greatly reduces the statistical probability that a positive diagnostic test will correspond with a true fracture, reducing the positive predictive value of an investigation.<\/jats:p>\n <\/jats:list-item>\n \n \u00bb There is no consensus reference standard for a true fracture; therefore, alternative statistical methods for calculating sensitivity, specificity, and positive and negative predictive values are required.<\/jats:p>\n <\/jats:list-item>\n \n \u00bb Clinical prediction rules that incorporate a set of demographic and clinical factors may allow stratification of secondary imaging, which, in turn, could increase the pretest probability of a scaphoid fracture and improve the diagnostic performance of the sophisticated radiographic investigations that are available.<\/jats:p>\n <\/jats:list-item>\n \n \u00bb Machine-learning-derived probability calculators may augment risk stratification and can improve through retraining, although these theoretical benefits need further prospective evaluation.<\/jats:p>\n <\/jats:list-item>\n \n \u00bb Convolutional neural networks (CNNs) are a form of artificial intelligence that have demonstrated great promise in the recognition of scaphoid fractures on radiographs. However, in the more challenging diagnostic scenario of a suspected or so-called \u201cclinical\u201d scaphoid fracture, CNNs have not yet proven superior to a diagnosis that has been made by an experienced surgeon.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>","DOI":"10.2106\/jbjs.rvw.20.00247","type":"journal-article","created":{"date-parts":[[2021,12,8]],"date-time":"2021-12-08T14:13:59Z","timestamp":1638972839000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":16,"title":["Diagnosis of Suspected Scaphoid Fractures"],"prefix":"10.2106","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3857-8628","authenticated-orcid":false,"given":"Paul H.C.","family":"Stirling","sequence":"first","affiliation":[{"name":"Edinburgh Orthopaedics and University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1072-1595","authenticated-orcid":false,"given":"Jason A.","family":"Strelzow","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1270-2742","authenticated-orcid":false,"given":"Job N.","family":"Doornberg","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Trauma Surgery, University Medical Centre Groningen, UMCG, Groningen, the Netherlands"},{"name":"Department of Orthopaedic and Trauma Surgery, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6125-7112","authenticated-orcid":false,"given":"Timothy O.","family":"White","sequence":"additional","affiliation":[{"name":"Edinburgh Orthopaedics and University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4626-6598","authenticated-orcid":false,"given":"Margaret M.","family":"McQueen","sequence":"additional","affiliation":[{"name":"Edinburgh Orthopaedics and University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5317-1300","authenticated-orcid":false,"given":"Andrew D.","family":"Duckworth","sequence":"additional","affiliation":[{"name":"Edinburgh Orthopaedics and University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,12]]},"reference":[{"issue":"1","key":"r1-20240731","first-page":"45","article-title":"Choosing a strategy for the diagnostic management of suspected scaphoid fracture: a cost-effectiveness analysis","volume":"36","author":"Tiel-van Buul","year":"1995","journal-title":"J Nucl Med"},{"issue":"1","key":"r2-20240731","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1302\/0301-620X.90B1.19767","article-title":"Percutaneous screw fixation versus conservative treatment for fractures of the waist of the scaphoid: a prospective randomised study","volume":"90","author":"McQueen","year":"2008","journal-title":"J Bone Joint Surg Br"},{"issue":"2","key":"r3-20240731","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1054\/JHSB.1998.0109","article-title":"Time off work due to scaphoid fractures and other carpal injuries in The Netherlands in the period 1990 to 1993","volume":"24","author":"van der Molen","year":"1999","journal-title":"J Hand Surg [Br]"},{"issue":"6","key":"r4-20240731","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.2214\/ajr.177.6.1771257","article-title":"Cost-effectiveness of immediate MR imaging versus traditional follow-up for revealing radiographically occult scaphoid fractures","volume":"177","author":"Dorsay","year":"2001","journal-title":"AJR Am J Roentgenol"},{"issue":"3","key":"r5-20240731","first-page":"677","article-title":"Diagnosis of occult scaphoid fracture with high-spatial-resolution sonography: a prospective blind study","volume":"59","author":"Fusetti","year":"2005","journal-title":"J Trauma"},{"issue":"5","key":"r6-20240731","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1177\/1753193409105322","article-title":"Cost-effectiveness of MRI in managing suspected scaphoid fractures","volume":"34","author":"Hansen","year":"2009","journal-title":"J Hand Surg Eur"},{"issue":"1201","key":"r7-20240731","first-page":"U1049","article-title":"Accident Compensation Corporation. 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