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

Fallahi, Farshid; Oliver, Rhiannon; Mandalia, Sachin S.; Jonker, Leon

doi:10.1007/s00590-013-1372-1

Cited by 4 publications

(4 citation statements)

References 25 publications

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“…14,15 NICE guidelines recommend MRI as the imaging modality of choice if plain radiographs are normal. 4 There is increasing demand for this resource, acutely and electively, within orthopaedics, as well as other specialties, making time in the scanner very precious. The SUSPECT study group recently found that only a minority of emergency departments in the UK have direct availability of MRI scans to diagnose clinically suspected scaphoid fractures.…”

Section: Discussionmentioning

confidence: 99%

“…MRI is considered the gold standard of imaging methods for demonstrating occult scaphoid pathology, with the National Institute for Clinical Excellence (NICE) recommending early consideration of MRI in the assessment of potential scaphoid fracture. 4 However, MRI scans are costly and the demand for the service is high, with limited accessibility to scanners within most NHS institutions.…”

Section: Introductionmentioning

confidence: 99%

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Patient-directed follow-up for the clinical scaphoid fracture

Chaturvedi,

Russell,

Farrugia

et al. 2024

Bone Jt Open

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AimsOccult (clinical) injuries represent 15% of all scaphoid fractures, posing significant challenges to the clinician. MRI has been suggested as the gold standard for diagnosis, but remains expensive, time-consuming, and is in high demand. Conventional management with immobilization and serial radiography typically results in multiple follow-up attendances to clinic, radiation exposure, and delays return to work. Suboptimal management can result in significant disability and, frequently, litigation.MethodsWe present a service evaluation report following the introduction of a quality-improvement themed, streamlined, clinical scaphoid pathway. Patients are offered a removable wrist splint with verbal and written instructions to remove it two weeks following injury, for self-assessment. The persistence of pain is the patient’s guide to ‘opt-in’ and to self-refer for a follow-up appointment with a senior emergency physician. On confirmation of ongoing signs of clinical scaphoid injury, an urgent outpatient ‘fast’-wrist protocol MRI scan is ordered, with instructions to maintain wrist immobilization. Patients with positive scan results are referred for specialist orthopaedic assessment via a virtual fracture clinic.ResultsFrom February 2018 to January 2019, there were 442 patients diagnosed as clinical scaphoid fractures. 122 patients (28%) self-referred back to the emergency department at two weeks. Following clinical review, 53 patients were discharged; MRI was booked for 69 patients (16%). Overall, six patients (< 2% of total; 10% of those scanned) had positive scans for a scaphoid fracture. There were no known missed fractures, long-term non-unions or malunions resulting from this pathway. Costs were saved by avoiding face-to-face clinical review and MRI scanning.ConclusionA patient-focused opt-in approach is safe and effective to managing the suspected occult (clinical) scaphoid fracture.Cite this article: Bone Jt Open 2024;5(2):117–122.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Patient-directed follow-up for the clinical scaphoid fracture

Chaturvedi,

Russell,

Farrugia

et al. 2024

Bone Jt Open

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“…A previous study has revealed that 16% of scaphoid fractures may be radiographi-cally occult. 20 Stevenson et al 21 recommended early CT test to manage suspected occult scaphoid fractures for its accurate diagnosis, while Fallahi et al 22 considered that MRI scan should play a major role in the management of clinically suspected scaphoid fracture. For this reason, one should have a high level of suspicion when assessing young patients with radial wrist pain, and CT or MRI should be obtained to further assess for a nondisplaced scaphoid fracture.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with union time of acute middle-third scaphoid fractures: an observational study

Zhao

Tian

Kong

et al. 2018

TCRM

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BackgroundThe aim of this study was to investigate the union time of acute middle-third scaphoid fractures following treatments and to analyze the effect of different factors on late union.Patients and methodsWe retrospectively reviewed patients with acute middle-third scaphoid fracture at our institution between January 2013 and December 2017. Patient demographics, fracture characteristics, and treatment strategy, such as age, gender, body mass index, habit of smoking, sides of injury, dominant hand, ulnar variance, multiple fractures, and treatment methods, were investigated. Univariate and multivariate analyses were used to identify possible predictive factors.ResultsA total of 132 patients with scaphoid fracture were included in our study. Operation was performed in 67 patients (50.8%), and conservative treatment was performed in the other 65 patients (49.2%). The union time was 7.2±0.5 weeks. In the multivariate logistic regression analysis, late diagnosis (odds ratio, 1.247; 95% CI, 1.022–1.521) and conservative treatment method (odds ratio, 1.615; 95% CI, 1.031–2.528) were identified as 2 independent predictors of late union in scaphoid fractures patients. Other parameters were not demonstrated to be predictive factors.ConclusionLate diagnosis and conservative treatment were two factors associated with late union. Long time of follow-up is necessary for patient with these factors.

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“…In this way, the department can avoid overtreatment of the patient, which can include needless immobilization, and undertreatment of the patient, which can lead to complications such as non-union. However, recent studies suggested using MRI to diagnose scaphoid fracture ( 12 , 17 , 19 ). Future studies that use a larger sample size are needed to determine the value of clinical examination and plain radiographs in the diagnosis of scaphoid fracture.…”

Section: Discussionmentioning

confidence: 99%

How Trustworthy Are Clinical Examinations and Plain Radiographs for Diagnosis of Scaphoid Fractures?

Ghane¹,

Rezaee‐Zavareh²,

Emami-Meibodi³

et al. 2016

Trauma Mon

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Background: Sometimes patients with a scaphoid fracture, especially in an acute phase of injury, can have normal radiographs and, therefore, initial diagnosis of the scaphoid fracture may be neglected. In this study, we determined the value in of clinical examination and a radiograph in the diagnosis of scaphoid fracture based on the results of a two-week follow-up magnetic resonance imaging (MRI).

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

Abstract: 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.

Cited by 4 publications

References 25 publications

Patient-directed follow-up for the clinical scaphoid fracture

Patient-directed follow-up for the clinical scaphoid fracture

Factors associated with union time of acute middle-third scaphoid fractures: an observational study

How Trustworthy Are Clinical Examinations and Plain Radiographs for Diagnosis of Scaphoid Fractures?

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