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

Fallahi, Farshid, Oliver, Rhiannon, Mandalia, Sachin S. and Jonker, Leon (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:	06 Jul 2021 08:02
URI:	https://insight.cumbria.ac.uk/id/eprint/5314

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