Archives of Academic Emergency Medicine. 2019; 7 (1): e51

LE T T E R TO ED I TO R

Compression Test for Diagnosis of Phalangeal Fracture; a
Letter to Editor
Naser Mohamad Karimi1, Faeze Zeinali.N2∗

1. Department of Emergency Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

Received: July 2019; Accepted: August 2019; Published online: 15 September 2019

Cite this article as: Mohamad Karimi N, Zeinali.N F. Compression Test for Diagnosis of Phalangeal Fracture; a Letter to Editor. Arch Acad

Emerg Med. 2019; 7(1): e51.

Physical examination is the most important procedure for ex-

amining traumatized patients and ruling out possible bone

fractures. Edema, deformity, ecchymosis, tenderness on

trauma location, and limited bone movement are among the

signs of fracture. The diagnosis is documented by plain ra-

diography. The number of false positive cases in this test in-

crease in the presence of soft tissue injury along with bone

damage. In this case, a great number of X-rays will be taken

daily and many patients will be exposed to radiation, unnec-

essarily (1). The question to be fully answered is whether all

cases of trauma and pain require radiographs or not?

In cases of suspicion to scaphoid bone fractures, scaphoid

compression (compressing a patient’s thumb along the line

of the first metacarpal bone) is used as a clinical test. This

test is said to have sensitivity of 70.5%, specificity of 21.8%,

and predictive value of 41.9% for diagnosing scaphoid bone

fracture (2). Given the similarities present in force trans-

mission and creation of pain in both scaphoid bone and

phalanges, we assessed the mentioned maneuver in a simi-

lar fashion for phalanges and investigated the value of “ax-

ially/longitudinally compressing a patient’s finger along the

longitudinal line of phalanxes” as a test for predicting pha-

langeal bone fracture in patients with traumatized pha-

langes.

In this study, 100 patients with direct blunt trauma to hand

were examined. The mean age of patients was 31.18 ± 11.05
years (85% male). All patients underwent compression test

and radiography. One emergency medicine physician and

one radiologist interpreted the radiographies, separately. The

total sensitivity and specificity of test were 0.673 (95% CI:

0.485 – 0.895) and 0.875 (95% CI: 0.987 – 0.692), respectively.

Sensitivity and specificity of test for diagnosis of proximal

phalanx fracture were 100% and 100%, respectively.

∗Corresponding Author: Faeze Zeinali.N; Emergency Department, Shahid
Sadoughi Hospital, Yazd, Iran. Tel: 00989132749231, Email: f.zeinali@ssu.ac.ir

Our findings demonstrated that in the presence of fracture

involving the whole width of phalange of each finger, the test

will be positive. Hence, this test enjoys a high predictive value

for diagnosing bone fractures and it can be used to reduce

the need for X-rays ordered for phalanges. Of course, some

exceptions ought to be clarified. Regarding joints, 26 vic-

tims had pain and tenderness on phalangeal joints. However,

only 5 of them felt severe pain on scaphoid compression test,

while, interestingly, none of them had fractures on radiogra-

phy. On the other hand, out of the 21 victims that had no pain

during the examination, 3 had avulsion fracture (FX) in the

radiography, which also involved the joint surface, slightly.

This may be attributed to the point that this type of fracture

does not involve all the width of the phalanx and is not lo-

cated on the longitudinal axis of the bone and in the path of

force transmission, so the patient does not feel any pain in

this region.

On the whole, it may be concluded that considering the pres-

ence of various types of soft tissues in the joint, such as joint

capsule, synovial fluid, and tendons in the joint space, force

transmission is not done completely; hence, this test is not of

much diagnostic value in diagnosing joint damage.

1. Appendix

1.1. Acknowledgements

Dr. Naser Mohamad Karimi: Conceived and designed the

analysis, collected the data and analysis.

Dr. Faeze Zeinali.N: Performed the analysis, wrote the paper,

and submitted.

1.2. Author’s contribution

Dr. Naser Mohamad Karimi: Conceived and designed the

analysis, collected the data and analysis.

Authors ORCIDs
Faeze Zeinali.N: 0000-0003-1524-3112

This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0).
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F. Zeinali.N et al. 2

1.3. Conflict of interest

The authors declare that there is no conflict of interest re-

garding the present study.

1.4. Funding and support

There was no financial payment to the authors for this study.

References

1. Wall B, Haylock R, Jansen J, Hillier M, Hart D, Shrimp-

ton P. Radiation risks from medical X-ray examinations as

a function of the age and sex of the patient. Health Pro-

tection Agency, Centre for Radiation, Chemical and Envi-

ronmental Hazards Chilton, Didcot Oxfordshire OX11 0RQ

ISBN. 2011:978-0.

2. Esberger D. What value the scaphoid compression test?

The Journal of Hand Surgery: British & European Volume.

1994;19(6):748-9.

This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0).
Downloaded from: http://journals.sbmu.ac.ir/aaem


	Appendix
	References