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Determination of Radiography Requirement with Physical Examination in Elbow Trauma

Yıl 2022, Cilt: 12 Sayı: 1, 66 - 70, 15.01.2022
https://doi.org/10.16899/jcm.928008

Öz

Objective: The purpose of this study was to estimate the presence of fracture and to determine radiography requirements through results obtained by evaluating the physical examination findings in elbow injury.
Material and Methods: This was a single center prospective study. All patients were evaluated in terms of trauma mechanism, inspection findings, presence of pain at palpation, pain with active movement, circulatory examination and loss of sensation. Sensitivity, specificity, positive and negative predictive value (NPV) were determined for each sign and each examination finding.
Results: The study was performed with 47 patients. Fracture was determined in 10 patients (21.2%). Presence of pain at the elbow extansion, forearm supination (FS), medial epicondyle (ME) palpation and forearm pronation tests exhibited high sensitivity (100%, 100%, 90%, and 80%, respectively) and high NPV (100%, 95%, 96.4%, and 91%, respectively) for elbow fracture. These four tests produced significant p values (0.088, 0.012, 0.001, and 0.079, respectively) in elbow fractures. Combining the pain at FS and ME palpation tests exhibited 90% sensitivity, and 96.7% NPV.
Conclusions: Positivity on any one of the four tests employed increases the probability of fracture and is sufficient for elbow radiography to be recommended in patients presenting due to elbow injury. However, radiography may not be required if combined FS and ME palpation test findings are negative in this patients.

Kaynakça

  • 1. Freed HA, Shields NN. Most frequently overlooked radiographically apparent fractures in a teaching hospital emergency department. Ann Emerg Med. 1984 Oct;13(10):900-4.
  • 2. Lennon RI, Riyat MS, Hilliam R, Anathkrishnan G, Alderson G. Can a normal range of elbow movement predict a normal elbow x ray? Emerg Med J. 2007 Feb;24(2):86-8.
  • 3. Nalbantoğlu U, Gereli A. Fracture dislocations of the elbow: overview and classification. TOTBID Dergisi 2014; 12:51-56.
  • 4. Appelboam A, Reuben AD, Benger JR, Beech F, Dutson J, Haig S, et al. Elbow extension test to rule out elbow fracture: multicentre, prospective validation and observational study of diagnostic accuracy in adults and children. BMJ. 2008 Dec 9;337:a2428.
  • 5. Stiell IG, Greenberg GH, McKnight RD, Nair RC, McDowell I, Reardon M, et al. Decision rules for the use of radiography in acute ankle injuries. Refinement and prospective validation. JAMA. 1993 Mar 3;269(9):1127-32.
  • 6. Stiell IG, Wells GA, McDowell I, Greenberg GH, McKnight RD, Cwinn AA, et al. Use of radiography in acute knee injuries: need for clinical decision rules. Acad Emerg Med 1995;2:966-73.
  • 7. Perry JJ, Stiell IG. Impact of clinical decision rules on clinical care of traumatic injuries to the foot and ankle, knee, cervical spine, and head. Injury 2006;37:1157-65.
  • 8. Docherty MA, Schwab RA, Ma OJ. Can elbow extension be used as a test of clinically significant injury? South Med J 2002;95:539-41.
  • 9. Hawksworth CR, Freeland P. Inability to fully extend the injured elbow: an indicator of significant injury. Arch Emerg Med 1991;8:253-6
  • 10. Turkmen S, Cansu A, Karaca Y, Baki ME, Eroglu O, Tatli O, et al. Determination of radiography requirement in wrist trauma. Am J Emerg Med. 2015 Sep;33(9):1269-72.
  • 11. Karaca Y, Turkmen S, Cansu A, Baki ME, Eroglu O, Tatli O, et al. A study to develop clinical decision rules for the use of radiography in wrist trauma: Karadeniz wrist rules. Am J Emerg Med. 2016 Nov;34(11):2074-2078.
  • 12. Jie KE, van Dam LF, Verhagen TF, Hammacher ER. Extension test and ossal point tenderness cannot accurately exclude significant injury in acute elbow trauma. Ann Emerg Med. 2014 Jul;64(1):74-8.
  • 13. Darracq MA, Vinson DR, Panacek EA. Preservation of active range of motion after acute elbow trauma predicts absence of elbow fracture. Am J Emerg Med. 2008 Sep;26(7):779-82
  • 14. Arundel D, Williams P, Townend W. Deriving the East Riding Elbow Rule (ER2): a maximally sensitive decision tool for elbow injury. Emerg Med J. 2014 May;31(5):380-3.

Dirsek Travmasında Fizik Muayene Bulguları ile Radyografi Gerekliliğinin Belirlenmesi

Yıl 2022, Cilt: 12 Sayı: 1, 66 - 70, 15.01.2022
https://doi.org/10.16899/jcm.928008

Öz

Amaç: Bu çalışmada dirsek travmasında fizik muayene ve dirsek eklem fonksiyonlarını ölçen bazı testlerin yapılması ve bu veriler ışığında hangi hastalarda kırık olabileceğinin değerlendirilmesi amaçlanmaktadır.
Gereç ve Yöntem: Bu prospektif klinik çalışmada, tüm hastalar travmanın mekanizması, inspeksiyon bulguları, palpasyon ile ağrı varlığı, aktif hareket ile ağrı varlığı, dolaşım muayenesi ve duyu kaybı açısından değerlendirildi. Tüm semptom ve bulguların sensitivite, spesivite, pozitif prediktif değer ve negatif prediktif değerleri (NPV) istatistiksel olarak belirlendi.
Bulgular: Çalışma 47 hasta ile çalışma yürütüldü. Toplamda 10 hastada kırık saptandı (%21,2). Dirsek ekstansiyonu, ön kol supinasyonu, medial epikondil palpasyonu ve ön kol pronasyon testleri ile ağrı varlığının dirsek kırığı için sensitivitesi yüksekti ( sırasıyla, %100, %100,%90 ve %80). Dirsek kırığı için bu 4 testin p değeri anlamlı olarak tespit edildi (sırasıyla, 0.088, 0.012, 0.001, and 0.079 ). Ön kol supinasyonu ve medial epikondil palpasyon testlerinin kombine değerlendirilmesinin sensitivitesi %90, spesifitesi %81 ve NPS’si %96 olarak tespit edildi.
Sonuç: Acil servise dirsek yaralanması ile başvuran hastalarda bu 4 testten birinin pozitif olması fraktür olma olasılığını artırmakta olup dirsek grafisi istenmesi için yeterlidir. Bu hastalarda ön kol supinasyon ve medial epikondil palpasyon testleri kombine kullanıldığında sonuç negatif ise radyografi istenmesine gerek olmayabilir.

Kaynakça

  • 1. Freed HA, Shields NN. Most frequently overlooked radiographically apparent fractures in a teaching hospital emergency department. Ann Emerg Med. 1984 Oct;13(10):900-4.
  • 2. Lennon RI, Riyat MS, Hilliam R, Anathkrishnan G, Alderson G. Can a normal range of elbow movement predict a normal elbow x ray? Emerg Med J. 2007 Feb;24(2):86-8.
  • 3. Nalbantoğlu U, Gereli A. Fracture dislocations of the elbow: overview and classification. TOTBID Dergisi 2014; 12:51-56.
  • 4. Appelboam A, Reuben AD, Benger JR, Beech F, Dutson J, Haig S, et al. Elbow extension test to rule out elbow fracture: multicentre, prospective validation and observational study of diagnostic accuracy in adults and children. BMJ. 2008 Dec 9;337:a2428.
  • 5. Stiell IG, Greenberg GH, McKnight RD, Nair RC, McDowell I, Reardon M, et al. Decision rules for the use of radiography in acute ankle injuries. Refinement and prospective validation. JAMA. 1993 Mar 3;269(9):1127-32.
  • 6. Stiell IG, Wells GA, McDowell I, Greenberg GH, McKnight RD, Cwinn AA, et al. Use of radiography in acute knee injuries: need for clinical decision rules. Acad Emerg Med 1995;2:966-73.
  • 7. Perry JJ, Stiell IG. Impact of clinical decision rules on clinical care of traumatic injuries to the foot and ankle, knee, cervical spine, and head. Injury 2006;37:1157-65.
  • 8. Docherty MA, Schwab RA, Ma OJ. Can elbow extension be used as a test of clinically significant injury? South Med J 2002;95:539-41.
  • 9. Hawksworth CR, Freeland P. Inability to fully extend the injured elbow: an indicator of significant injury. Arch Emerg Med 1991;8:253-6
  • 10. Turkmen S, Cansu A, Karaca Y, Baki ME, Eroglu O, Tatli O, et al. Determination of radiography requirement in wrist trauma. Am J Emerg Med. 2015 Sep;33(9):1269-72.
  • 11. Karaca Y, Turkmen S, Cansu A, Baki ME, Eroglu O, Tatli O, et al. A study to develop clinical decision rules for the use of radiography in wrist trauma: Karadeniz wrist rules. Am J Emerg Med. 2016 Nov;34(11):2074-2078.
  • 12. Jie KE, van Dam LF, Verhagen TF, Hammacher ER. Extension test and ossal point tenderness cannot accurately exclude significant injury in acute elbow trauma. Ann Emerg Med. 2014 Jul;64(1):74-8.
  • 13. Darracq MA, Vinson DR, Panacek EA. Preservation of active range of motion after acute elbow trauma predicts absence of elbow fracture. Am J Emerg Med. 2008 Sep;26(7):779-82
  • 14. Arundel D, Williams P, Townend W. Deriving the East Riding Elbow Rule (ER2): a maximally sensitive decision tool for elbow injury. Emerg Med J. 2014 May;31(5):380-3.
Toplam 14 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Orjinal Araştırma
Yazarlar

Mücahit Günaydın 0000-0002-2215-986X

Vildan Özer 0000-0002-2514-5674

Yunus Karaca 0000-0002-0947-0565

Ali Aygun 0000-0002-5190-1445

Özgür Tatlı 0000-0003-0263-7630

Ayşegül Cansu 0000-0002-5077-3349

Abdulkadir Gündüz 0000-0001-8591-9769

Yayımlanma Tarihi 15 Ocak 2022
Kabul Tarihi 10 Kasım 2021
Yayımlandığı Sayı Yıl 2022 Cilt: 12 Sayı: 1

Kaynak Göster

AMA Günaydın M, Özer V, Karaca Y, Aygun A, Tatlı Ö, Cansu A, Gündüz A. Determination of Radiography Requirement with Physical Examination in Elbow Trauma. J Contemp Med. Ocak 2022;12(1):66-70. doi:10.16899/jcm.928008