The management of suspected scaphoid fractures in English hospitals: a national survey

Smith, Jessi L.; House, Robyn H.; Gallagher, Jessica; Phillips, Alistair

doi:10.1097/mej.0000000000000228

Cited by 11 publications

(16 citation statements)

References 20 publications

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“…3,4 However, MRI may not be freely and readily accessible in every institution, 5 potentiating a disparity in treatment which already exists in the UK. [6][7][8][9][10] Although there is evidence to suggest that nonunion of a scaphoid fracture is more likely to occur when there has been no initial immobilization, 11 there is no evidence to suggest that the natural history of an occult scaphoid fracture differs with a delay to immobilization in a splint or plaster cast. The rate of nonunion in established fractures of the scaphoid is approximately 10%, 12 and this is likely to be far lower in undisplaced fractures.…”

Section: Cite This Article: Bone Joint J 2022;104-b(6):709-714 Introd...mentioning

confidence: 99%

Virtual management of clinically suspected scaphoid fractures

Stirling

Simpson

Ring

et al. 2022

The Bone & Joint Journal

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Aims The aim of this study was to describe the introduction of a virtual pathway for the management of patients with a suspected fracture of the scaphoid, and to report patient-reported outcome measures (PROMs) and satisfaction following treatment using this service. Methods All adult patients who presented with a clinically suspected scaphoid fracture that was not visible on radiographs at the time of presentation during a one-year period were eligible for inclusion in the pathway. Demographic details, findings on examination, and routine four-view radiographs at the time of presentation were collected. All radiographs were reviewed virtually by a single consultant hand surgeon, with patient-initiated follow-up on request. PROMs were assessed at a minimum of one year after presentation and included the abbreviated version of the Disabilities of the Arm, Shoulder and Hand Score (QuickDASH), the EuroQol five-dimension five-level health questionnaire (EQ-5D-5L), the Net Promoter Score (NPS), and return to work. Results A total of 221 patients were referred to the virtual pathway. Their mean age was 41 years (range 16 to 87) and there were 99 male patients (45%). A total of 189 patients (86%) were discharged with advice and 19 (9%) were recalled for clinical review: seven with an undisplaced scaphoid fracture, six with another fracture of the hand or wrist, two with a scapholunate ligament injury, and four in whom no abnormality was detected. A total of 13 patients (6%) initiated follow-up with the hand service: no fracture or ligament injury was identified in this group. PROMs were available for 179 patients (81%) at a mean follow-up of 19 months (range 13 to 33). The median QuickDASH score was 2.3 (interquartile range (IQR) 0 to 15.9), the median EQ-5D-5L was 0.85 (IQR 0.73 to 1.00), the NPS was 76, and 173 patients (97%) were satisfied with their treatment. There were no documented cases of symptomatic nonunion one year following injury. Conclusion We describe the introduction of a virtual pathway for the management of patients with a suspected scaphoid fracture. We found high levels of patient satisfaction, excellent PROMs, and no detrimental effects in the vast majority of cases. Cite this article: Bone Joint J 2022;104-B(6):709–714.

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Section: Cite This Article: Bone Joint J 2022;104-b(6):709-714 Introd...mentioning

confidence: 99%

Virtual management of clinically suspected scaphoid fractures

Stirling

Simpson

Ring

et al. 2022

The Bone & Joint Journal

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“…While these advanced imaging techniques have a better sensitivity and specificity than radiography (10,11), they lack good positive predictive values, and their improved sensitivity is generally associated with a reduced specificity and vice versa (12,13). Consequently, there is no consensus today on a gold standard imaging technique for scaphoid fractures (14,15).…”

Section: Introductionmentioning

confidence: 99%

The Feasibility of High-Resolution Peripheral Quantitative Computed Tomography (HR-pQCT) in Patients with Suspected Scaphoid Fractures

Bevers

Daniels

Wyers

et al. 2020

Journal of Clinical Densitometry

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“…Despite the acknowledged benefits of using advanced imaging, UK and international surveys [23][24][25] confirm that serial x-rays continued to be the standard diagnostic protocol for imaging. Other modalities are often only available late in the diagnostic pathway, acknowledged within the 2013 Royal College of Emergency Medicine guidance.…”

Section: Introductionmentioning

confidence: 99%

“…4 As a result strategies for the management of this patient group vary, with many requiring patients to attend multiple follow up clinics, with subsequent pressures on resources, particularly for EDs. 25,27 Centres are now exploring different strategies to manage patients, including the use of virtual clinics, 28 although these have not been universally adopted and still require imaging departments to be innovative to improve the overall patient pathway.…”

Section: Introductionmentioning

confidence: 99%

Exploring the use of extremity cone beam computed tomography (CBCT) technology in the emergency department (ED) for patients with suspected scaphoid fracture

Harris¹,

Snaith²

2020

http://isrctn.com/

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The management of suspected scaphoid fractures in English hospitals: a national survey

Abstract: This is still considerable variability in the way these patients are managed in England. Further work needs to be undertaken to establish the most appropriate way to manage patients with wrist injuries with ongoing clinical suspicion of scaphoid fracture.

Cited by 11 publications

References 20 publications

Virtual management of clinically suspected scaphoid fractures

Virtual management of clinically suspected scaphoid fractures

The Feasibility of High-Resolution Peripheral Quantitative Computed Tomography (HR-pQCT) in Patients with Suspected Scaphoid Fractures

Exploring the use of extremity cone beam computed tomography (CBCT) technology in the emergency department (ED) for patients with suspected scaphoid fracture

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