Detecting suspected scaphoid fractures? the role of different imaging modalities within a district general hospital during the pandemic
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20240403Keywords:
Scaphoid fracture, Wrist injury, Wrist painAbstract
Background: This study evaluates the effectiveness of magnetic resonance imaging (MRI) versus computerised tomography (CT) scans for persistent wrist pain at the thumb base following injury in adults and children during covid. This was part of a pathway introduced as access to MRI scan was limited.
Methods: Patients were identified as having possible scaphoid fractures within the emergency department but had no fracture identified on initial imaging over a 3-month period. These were triaged to a scaphoid pathway during the covid pandemic from a virtual clinic. Patients were reviewed clinically and radiographically within the hand clinic using further imaging with CT or MRI scan.
Results: During the study time 45 patients with scaphoid fractures were detected on initial radiography in ED and 187 with suspected scaphoid fractures were selected for further review. Ninety (48%) were referred to the hand clinic where 2 (1%) scaphoid fractures were diagnosed on a second radiograph and ninety-seven (52%) were to be seen in an upper limb clinic where 2 (1%) further fractures were detected. 92% of scaphoid fractures were identified on radiography either in ED or orthopaedic clinic. Of the remaining 178 with two negative radiographs further imaging was requested in 45 cases (25%). Pathology was found in 17 (58%) MRI scans and in 7 (39%) CT scans.
Conclusions: Imaging needs to be timely to enable effective treatment. Obtaining MRI scans while diagnostically superior is not always achievable especially in times of resource depletion. Back up pathways using alternative imaging can be effective.
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References
Duckworth AD, Jenkins PJ, Aitken SA, Clement ND, Court-Brown CM, McQueen MM. Scaphoid fracture epidemiology. J Trauma Acute Care Surg. 2012;72(2):E41.
Laulan J, Marteau E, Bacle G. Wrist osteoarthritis. Orthop Traumatol Surg Res. 2015;101(1):S1-9.
Bergh TH, Lindau T, Soldal LA, Bernardshaw SV, Behzadi M, Steen K et al. Clinical scaphoid score (CSS) to identify scaphoid fracture with MRI in patients with normal x-ray after a wrist trauma. Emergency Med J. 2014;31(8):659-64.
Rhemrev SJ, Ootes D, Beeres FJ, Meylaerts SA, Schipper IB. Current methods of diagnosis and treatment of scaphoid fractures. Int J Emergency Med. 2011;4(1).
Mallee WH, Henny EP, Van Dijk CN, Kamminga SP, Van Enst WA, Kloen P. Clinical diagnostic evaluation for scaphoid fractures: a systematic review and meta-analysis. J Hand Surg. 2014;39(9):1683-91.
Parvizi J, Wayman J, Kelly P, Moran CG. Combining the clinical signs improves diagnosis of scaphoid fractures: a prospective study with follow-up. J Hand Surg Bri Europ. 1998;23(3):324-7.
Duckworth AD, Buijze GA, Moran M, Gray A, Ring D, McQueen MM. Predictors of fracture following suspected injury to the scaphoid. J Bone Joint Surg Brit. 2012;94(7):961-8.
Trigg M, Reeves PJ. The efficacy of plain films vs MRI in the detection of scaphoid fractures. Radiography. 2007;13(1):56-64.
Low G, Raby N. Can follow-up radiography for acute scaphoid fracture still be considered a valid investigation? Clin Radiol. 2005;60(10):1106-10.
Jamjoom BA, Davis TRC. Why scaphoid fractures are missed. A review of 52 medical negligence cases. Injury. 2019;50(7):1306-8.
Harrison W, Newton AW, Cheung G. The litigation cost of negligent scaphoid fracture management. Europ J Emergency Med. 2015 ;22(2):142-3.
Tiel-van Buul MMC, Van Beek EJR, Broekhuizen AH, Nooitgedacht EA, Davids PHP, Bakker AJ. Diagnosing scaphoid fractures: radiographs cannot be used as a gold standard! Injury. 1992;23(2):77-9.
Brydie A, Raby N. Early MRI in the management of clinical scaphoid fracture. Brit J Radiol. 2003;76(905):296-300.
Evidence: Fractures (non-complex): Assessment and Management: Guidance. Available at: https://www.nice.org.uk/guidance/ng38/evidence. Accessed on 31 March 2023.
Dean BJF. The management of suspected scaphoid fractures in the UK: a national cross-sectional study. Bone Joint Open. 2021;2(11):997-1003.
Bäcker HC, Wu CH, Strauch RJ. Systematic review of diagnosis of clinically suspected scaphoid fractures. J Wrist Surg. 2000;9(01):081-9.
Carpenter CR, Pines JM, Schuur JD, Muir M, Calfee RP, Raja AS. Adult scaphoid fracture. Academic Emergency Medicine. 2014 Feb;21(2):101-21.
Wells ME, Nicholson TC, Macias RA, Nesti LJ, Dunn JC. Incidence of scaphoid fractures and associated injuries at US trauma centers. J Wrist Surg. 2020;10(02):123-8.
Tiel-van Buul MM, Van Beek EJ, Borm JJ, Gubler FM, Broekhuizen AH, Van Royen EA. The value of radiographs and bone scintigraphy in suspected scaphoid fracture. A statistical analysis. J Hand Surg. 1993;18:403-6.
Dean BJF, Riley ND, McCulloch ER. A new acute scaphoid fracture assessment method: a reliability study of the ‘long axis’ measurement. BMC Musculoskelet Disord. 2018;19:310.
CT Scan. Fairfield Independent Hospital. Available at: https://www.fairfield.org.uk/tests/private-ct-scan/#:~:text=The%20cost%20of%20a%20CT,2%20Areas%20%E2%80%93%20%C2%A3600. Accessed on 31 March 2023.
Ian. MRI scan. Fairfield Independent Hospital. Available at: https://www.fairfield.org.uk/tests/private-mri-scan/. Accessed on 31 March 2023.
Treatment prices at Derby. Nuffield Health. Available at: https://www.nuffieldhealth.com/hospitals/derby/pricing. Accessed on 31 March 2023.
Mathews JD, Forsythe AV, Brady Z, Butler MW, Goergen SK, Byrnes GB et al. Cancer risk in 680 000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. BMJ. 2013;346.
Samson D, Jones M, Mahon A. Non-union of the trapezium: rare consequence of a rare injury. J Surgical Case Rep. 2018;2018(4):rjy076
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