Chen Mei Xi, Lamanna Daniel, Livock Holly, Smit Kevin, Carsen Sasha, Cheung Kevin
Faculty of Science, University of Ottawa, Ottawa, ON, Canada.
Division of Orthopaedic Surgery, CHEO (Children's Hospital of Eastern Ontario), Ottawa, ON, Canada.
Plast Surg (Oakv). 2025 Mar 21:22925503251322521. doi: 10.1177/22925503251322521.
Children presenting with suspicion of a scaphoid fracture pose a diagnostic challenge. Several imaging modalities such as plain radiograph (XR), computed tomography (CT), and magnetic resonance imaging (MRI) have been previously described. Timely and accurate diagnosis is important to avoid overtreatment, and complications, and allow for an earlier return to activity. It is unclear which imaging modality is the most diagnostically accurate for detecting scaphoid fractures in this population. A systematic review was conducted in concordance with established guidelines to elucidate the diagnostic accuracy of various imaging modalities for detecting scaphoid fractures in children. A comprehensive literature search of electronic databases was developed by experienced librarians. All steps were performed independently by 2 reviewers. Eight articles were included, all evaluating plain radiographs as the index test. One study evaluated CT. XR demonstrated sensitivity values ranging from 16% to 54%, with specificity of 71% to 100%. CT had 95% sensitivity with MRI as the reference standard. The included studies were limited by poor methodologic quality and heterogeneous patient populations. XR demonstrates a wide range of diagnostic accuracy in diagnosing scaphoid fractures in children. CT and MRI, while promising, are limited by a lack of evidence in children. More pediatric-specific prospective studies are required to guide the choice of diagnostic imaging in children with suspected scaphoid fractures.
疑似舟骨骨折的儿童诊断存在挑战。先前已描述了多种成像方式，如X线平片（XR）、计算机断层扫描（CT）和磁共振成像（MRI）。及时准确的诊断对于避免过度治疗、并发症以及早日恢复活动很重要。目前尚不清楚哪种成像方式对检测该人群的舟骨骨折诊断准确性最高。按照既定指南进行了一项系统评价，以阐明各种成像方式检测儿童舟骨骨折的诊断准确性。经验丰富的图书馆员对电子数据库进行了全面的文献检索。所有步骤均由两名审阅者独立完成。纳入了8篇文章，均将X线平片作为主要检测方法进行评估。一项研究评估了CT。以MRI作为参考标准，X线平片的敏感性值在16%至54%之间，特异性为71%至100%。CT的敏感性为95%。纳入的研究因方法学质量差和患者群体异质性而受到限制。X线平片在诊断儿童舟骨骨折方面显示出广泛的诊断准确性。CT和MRI虽然有前景，但因儿童缺乏证据而受到限制。需要更多针对儿童的前瞻性研究来指导疑似舟骨骨折儿童诊断性成像的选择。
