Early MRI can reliably detect radiologically occult scaphoid fractures and accurately delineate the anatomy of other injuries that may present with similar symptoms. This strategy avoids further radiation and can be incorporated as a part of an emergency department management pathway. Early and accurate diagnosis is in the patient's interest and allows timely intervention.

The authors found no significant difference in time to administration of analgesia between agents, but a learning curve has been identified. Sustained effort should be placed on the use of simple coanalgesia. The clinical performance of IND compares favourably with IVM in children with severe pain, and it remains an appropriate preferred agent.