Early MRI diagnostics for suspected scaphoid fractures subsequent to initial plain radiography

Fallahi, Farshid, Oliver, Rhiannon, Mandalia, Sachin S. and Jonker, Leon ORCID: https://orcid.org/0000-0001-5867-4663 (2013) Early MRI diagnostics for suspected scaphoid fractures subsequent to initial plain radiography. European Journal of Orthopaedic Surgery & Traumatology, 24 (7). pp. 1161-1166.

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Abstract

Aim
In the United Kingdom, diagnostic management of patients presenting to emergency department with a scaphoid injury varies. Follow-up plain radiographs, after an initial inconclusive X-ray, are common practice. We optimised the diagnostic pathway for these patients by focusing on the most appropriate diagnostic modality and on minimising the time to follow-up diagnostics.

Materials and methods
A baseline audit in the period 2008–2009 involving a total of 184 patients was conducted, and after the introduction of new local guidelines for scaphoid injury diagnostics, a follow-up audit involving 79 patients was undertaken in 2010–2012.

Results
In the original audit, 130 patients had only scaphoid radiographs, of which 23 underwent initial and follow-up X-rays, and 107 initial-only radiographs. Of those 23, just one single patient (4 %) displayed a scaphoid fracture. Others underwent three imaging procedures: initial radiographs, follow-up radiographs and either bone scan (41 patients) or MRI (13 patients). A further 6/41 (15 %) and 4/13 (31 %) fractures were detected by bone scan and MRI, respectively. In the re-audit, when MRI replaced follow-up X-rays and bone scans, 7 out of 77 (9 %) patients were diagnosed with scaphoid fracture. Time from initial plain radiograph to follow-up MRI was reduced from an original mean of 36 to 14 days during the re-audit period.

Conclusion
The introduction of early MRI enhances scaphoid injury diagnostics and accelerates patient management. We therefore endorse the introduction of this approach on a wider scale through an update of the clinical guidelines for scaphoid injuries.

Item Type:	Article
Journal / Publication Title:	European Journal of Orthopaedic Surgery & Traumatology
Publisher:	Springer
ISSN:	1633-8065
Departments:	Academic Departments > Nursing, Health & Professional Practice (NHPP)
Depositing User:	Christian Stretton
Date Deposited:	17 Dec 2019 10:48
Last Modified:	12 Jan 2024 12:01
URI:	https://insight.cumbria.ac.uk/id/eprint/5314

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