BACKGROUND The standard diagnostic work-up for hand and wrist fractures consists of history taking, physical examination and imaging if needed, but the supporting evidence for this work-up is limited. The purpose of this study was to systematically examine the diagnostic accuracy of tests for hand and wrist fractures. METHODS A systematic search for relevant studies was performed. Methodological quality was assessed and sensitivity (Se), specificity (Sp), accuracy, positive predictive value (PPV) and negative predictive value (NPV) were extracted from the eligible studies. RESULTS Of the 35 eligible studies, two described the diagnostic accuracy of history taking for hand and wrist fractures. Physical examination with or without radiological examination for diagnosing scaphoid fractures (five studies) showed Se, Sp, accuracy, PPV and NPV ranging from 15 to 100%, 13-98%, 55-73%, 14-73% and 75-100%, respectively. Physical examination with radiological examination for diagnosing other carpal bone fractures (one study) showed a Se of 100%, with the exception of the triquetrum (75%). Physical examination for diagnosing phalangeal and metacarpal fractures (one study) showed Se, Sp, accuracy, PPV and NPV ranging from 26 to 55%, 13-89%, 45-76%, 41-77% and 63-75%, respectively. Imaging modalities of scaphoid fractures showed predominantly low values for PPV and the highest values for Sp and NPV (24 studies). Magnetic Resonance Imaging (MRI), Computed Tomography (CT), Ultrasonography (US) and Bone Scintigraphy (BS) were comparable in diagnostic accuracy for diagnosing a scaphoid fracture, with an accuracy ranging from 85 to 100%, 79-100%, 49-100% and 86-97%, respectively. Imaging for metacarpal and finger fractures showed Se, Sp, accuracy, PPV and NPV ranging from 73 to 100%, 78-100%, 70-100%, 79-100% and 70-100%, respectively. CONCLUSIONS Only two studies were found on the diagnostic accuracy of history taking for hand and wrist fractures in the current review. Physical examination was of moderate use for diagnosing a scaphoid fracture and of limited use for diagnosing phalangeal, metacarpal and remaining carpal fractures. MRI, CT and BS were found to be moderately accurate for the definitive diagnosis of clinically suspected carpal fractures.

中文翻译：

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对指骨，掌骨和腕骨骨折的病史，体格检查和影像学的诊断准确性：系统综述。

背景技术用于手和腕部骨折的标准诊断检查包括病史采集，体格检查和必要时的影像学检查，但是该检查的支持证据有限。这项研究的目的是系统地检查手腕骨折的诊断准确性。方法对相关研究进行系统搜索。评估方法学质量，并从符合条件的研究中提取敏感性（Se），特异性（Sp），准确性，阳性预测值（PPV）和阴性预测值（NPV）。结果在35项合格的研究中，有2篇描述了手部和腕部骨折的病史诊断准确性。进行或不进行放射学检查以诊断舟骨骨折的身体检查（五项研究）显示，Se，Sp，准确性，PPV和NPV分别为15％至100％，13-98％，55-73％，14-73％和75-100％。体格检查和放射学检查以诊断其他腕骨骨折（一项研究）显示，除三叉形（75％）外，Se的Se为100％。体格检查诊断指骨和掌骨骨折（一项研究）显示，Se，Sp，准确性，PPV和NPV分别为26％至55％，13-89％，45-76％，41-77％和63-75％ 。舟骨骨折的影像学表现主要显示PPV值较低，而Sp和NPV值最高（24个研究）。磁共振成像（MRI），计算机断层扫描（CT），超声检查（US）和骨闪烁成像（BS）在诊断舟骨骨折方面的诊断准确性相当，其准确性范围为85至100％，79-100％，49 -100％和86-97％。掌骨和手指骨折的影像学检查显示，Se，Sp，准确性，PPV和NPV分别为73％至100％，78-100％，70-100％，79-100％和70-100％。结论在本综述中，仅发现两项关于手及腕部骨折的病史诊断准确性的研究。体格检查在诊断舟骨骨折方面用途适中，而在指骨，掌骨和腕腕骨折的诊断方面用途有限。发现MRI，CT和BS对临床怀疑的腕骨骨折的确诊具有中等准确性。结论在本综述中，仅发现两项关于手及腕部骨折的病史诊断准确性的研究。体格检查在诊断舟骨骨折方面用途适中，而在指骨，掌骨和腕骨其余部位的诊断方面用途有限。发现MRI，CT和BS对临床怀疑的腕骨骨折的确诊具有中等准确性。结论在本综述中，仅发现两项关于手及腕部骨折的病史诊断准确性的研究。体格检查在诊断舟骨骨折方面用途适中，而在指骨，掌骨和腕腕骨折的诊断方面用途有限。发现MRI，CT和BS对临床怀疑的腕骨骨折的确诊具有中等准确性。