Reliability of clinical tests for prediction of occult scaphoid fractures and cost benefit analysis of a dedicated scaphoid pathway

• Published in: The Journal of hand surgery, European volume Vol. 46; no. 3; p. 292
• Main Authors: Kodumuri, Preetham, McDonough, Andrew, Lyle, Victoria, Naqui, Zaf, Muir, Lindsay
• Format: Journal Article
• Language: English
• Published: England 01.03.2021
• Subjects: Scaphoid fracture; diagnosis; cost-benefit; MRI; clinical examination
• ISSN: 2043-6289
• DOI: 10.1177/1753193420979465

We reviewed the outcomes of our dedicated clinic for suspected scaphoid fractures. The primary outcome measure was to test the reliability of accurately diagnosing an occult scaphoid fracture with a combination of anatomical snuff box, scaphoid tubercle, longitudinal compression tenderness, ulnar deviation and the pinch test. Cost savings of the new patient pathway was our secondary outcome measure. Between December 2016 and March 2020, 922 patients were recruited at a mean of 12 days post-injury. Sixty-five per cent (  = 602) with a low clinical suspicion were discharged and 35% (  = 320) with a high clinical suspicion had same day MRI scan. Fifty-eight scaphoid fractures were diagnosed and treated with no nonunions reported. Anatomical snuff box tenderness was the most sensitive test (90%). A combination of five tests better excluded an occult fracture (80% accuracy). The dedicated scaphoid clinic pathway resulted in 350 fewer follow-up visits and an overall saving of £59,666. III.