Early MRI in the management of the clinical scaphoid fracture

OBJECTIVES: The 'clinical scaphoid fracture' remains a common problem faced by emergency physicians. Early magnetic resonance imaging (MRI) has been used to routinely investigate such patients presenting to the emergency department of Aberdeen Royal Infirmary since 2002. The aim of this study was to evaluate the effectiveness of this strategy in the diagnosis of occult scaphoid fracture.

METHODS: This was a retrospective cohort study of patients presenting with symptoms and signs suggestive of scaphoid injury and normal initial radiographs. Patients undergoing MRI evaluation of a suspected scaphoid injury between September 2002 and June 2008 were identified from records. The number of patients with scaphoid fractures and other significant pathology diagnosed on MRI was recorded.

RESULTS: A total of 651 patients were included in the study. A scaphoid fracture was diagnosed in 11% of patients. Using the χ test, there was evidence of an association between sex and type of injury (χ=58.0, P<0.001). Male patients were more likely to have scaphoid injuries; female patients were more likely to have no injury. There was also evidence of an association between age group and type of injury (χ=11.8, P=0.003). Those in the younger age group were more likely to have scaphoid injuries.

CONCLUSION: 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.