The utility of cross‐sectional imaging in the management of suspected scaphoid fractures

Introduction Scaphoid fractures are the commonest carpal bone fracture. If untreated they pose significant risk to patients, thus if a scaphoid fracture is suspected, patients are managed with immobilisation. Although scaphoid fractures may be difficult to diagnose on plain radiography, sometimes fo...

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Published inJournal of medical radiation sciences Vol. 66; no. 1; pp. 30 - 37
Main Authors Wijetunga, Asanka R., Tsang, Venessa H., Giuffre, Bruno
Format Journal Article
LanguageEnglish
Published United States Wiley Subscription Services, Inc 01.03.2019
John Wiley & Sons, Inc
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Abstract Introduction Scaphoid fractures are the commonest carpal bone fracture. If untreated they pose significant risk to patients, thus if a scaphoid fracture is suspected, patients are managed with immobilisation. Although scaphoid fractures may be difficult to diagnose on plain radiography, sometimes for months after injury, ongoing radiographic surveillance is preferred due to its low upfront cost. Patients in immobilising casts for long periods experience significant personal and social ramifications such as difficulty working and self‐caring. This study examines whether cross‐sectional imaging by computed tomography (CT) or magnetic resonance imaging (MRI) is quicker than serial X‐ray surveillance at allowing a scaphoid fracture to be either excluded or confirmed. Methods A retrospective record review was performed of the 1709 patients who presented to Royal North Shore Hospital in 2015 with wrist injuries, finding 104 patients clinically suspicious for a fractured scaphoid. Results All patients were examined by X‐ray during their initial hospital presentation, providing 33.7% of final diagnoses in 0.6 ± 1.7 days. However, if initial X‐ray proved inconclusive, subsequent serial X‐ray surveillance made a final diagnosis after a mean of 24.1 ± 17.2 days, with some being immobilised for up to 67 days before diagnosis. Cross‐sectional imaging significantly reduced diagnosis time to 9.8 ± 5.8 days (P = 0.0016), with a maximum immobilisation time of 24 days. Conclusion Cross‐sectional imaging allows for faster scaphoid fracture diagnosis than X‐ray. We propose a protocol for scaphoid fracture diagnosis wherein patients undergo two episodes of X‐ray separated by 7 days, followed by a single MRI if clinical suspicion remains, minimising unnecessary immobilisation. Delayed scaphoid fracture diagnosis is a cause of significant inconvenience to patients. This paper highlights the need for a scaphoid fracture diagnosis protocol, with patients being made to wait in immobilising casts for up to 67 days without a definitive diagnosis if X‐ray alone is used. When cross‐sectional imaging techniques are applied, a final diagnosis is reached much more rapidly, reducing the incidence of unnecessary wrist immobilisation.
AbstractList INTRODUCTIONScaphoid fractures are the commonest carpal bone fracture. If untreated they pose significant risk to patients, thus if a scaphoid fracture is suspected, patients are managed with immobilisation. Although scaphoid fractures may be difficult to diagnose on plain radiography, sometimes for months after injury, ongoing radiographic surveillance is preferred due to its low upfront cost. Patients in immobilising casts for long periods experience significant personal and social ramifications such as difficulty working and self-caring. This study examines whether cross-sectional imaging by computed tomography (CT) or magnetic resonance imaging (MRI) is quicker than serial X-ray surveillance at allowing a scaphoid fracture to be either excluded or confirmed. METHODSA retrospective record review was performed of the 1709 patients who presented to Royal North Shore Hospital in 2015 with wrist injuries, finding 104 patients clinically suspicious for a fractured scaphoid. RESULTSAll patients were examined by X-ray during their initial hospital presentation, providing 33.7% of final diagnoses in 0.6 ± 1.7 days. However, if initial X-ray proved inconclusive, subsequent serial X-ray surveillance made a final diagnosis after a mean of 24.1 ± 17.2 days, with some being immobilised for up to 67 days before diagnosis. Cross-sectional imaging significantly reduced diagnosis time to 9.8 ± 5.8 days (P = 0.0016), with a maximum immobilisation time of 24 days. CONCLUSIONCross-sectional imaging allows for faster scaphoid fracture diagnosis than X-ray. We propose a protocol for scaphoid fracture diagnosis wherein patients undergo two episodes of X-ray separated by 7 days, followed by a single MRI if clinical suspicion remains, minimising unnecessary immobilisation.
Abstract Introduction Scaphoid fractures are the commonest carpal bone fracture. If untreated they pose significant risk to patients, thus if a scaphoid fracture is suspected, patients are managed with immobilisation. Although scaphoid fractures may be difficult to diagnose on plain radiography, sometimes for months after injury, ongoing radiographic surveillance is preferred due to its low upfront cost. Patients in immobilising casts for long periods experience significant personal and social ramifications such as difficulty working and self‐caring. This study examines whether cross‐sectional imaging by computed tomography (CT) or magnetic resonance imaging (MRI) is quicker than serial X‐ray surveillance at allowing a scaphoid fracture to be either excluded or confirmed. Methods A retrospective record review was performed of the 1709 patients who presented to Royal North Shore Hospital in 2015 with wrist injuries, finding 104 patients clinically suspicious for a fractured scaphoid. Results All patients were examined by X‐ray during their initial hospital presentation, providing 33.7% of final diagnoses in 0.6 ± 1.7 days. However, if initial X‐ray proved inconclusive, subsequent serial X‐ray surveillance made a final diagnosis after a mean of 24.1 ± 17.2 days, with some being immobilised for up to 67 days before diagnosis. Cross‐sectional imaging significantly reduced diagnosis time to 9.8 ± 5.8 days (P = 0.0016), with a maximum immobilisation time of 24 days. Conclusion Cross‐sectional imaging allows for faster scaphoid fracture diagnosis than X‐ray. We propose a protocol for scaphoid fracture diagnosis wherein patients undergo two episodes of X‐ray separated by 7 days, followed by a single MRI if clinical suspicion remains, minimising unnecessary immobilisation.
Scaphoid fractures are the commonest carpal bone fracture. If untreated they pose significant risk to patients, thus if a scaphoid fracture is suspected, patients are managed with immobilisation. Although scaphoid fractures may be difficult to diagnose on plain radiography, sometimes for months after injury, ongoing radiographic surveillance is preferred due to its low upfront cost. Patients in immobilising casts for long periods experience significant personal and social ramifications such as difficulty working and self-caring. This study examines whether cross-sectional imaging by computed tomography (CT) or magnetic resonance imaging (MRI) is quicker than serial X-ray surveillance at allowing a scaphoid fracture to be either excluded or confirmed. A retrospective record review was performed of the 1709 patients who presented to Royal North Shore Hospital in 2015 with wrist injuries, finding 104 patients clinically suspicious for a fractured scaphoid. All patients were examined by X-ray during their initial hospital presentation, providing 33.7% of final diagnoses in 0.6 ± 1.7 days. However, if initial X-ray proved inconclusive, subsequent serial X-ray surveillance made a final diagnosis after a mean of 24.1 ± 17.2 days, with some being immobilised for up to 67 days before diagnosis. Cross-sectional imaging significantly reduced diagnosis time to 9.8 ± 5.8 days (P = 0.0016), with a maximum immobilisation time of 24 days. Cross-sectional imaging allows for faster scaphoid fracture diagnosis than X-ray. We propose a protocol for scaphoid fracture diagnosis wherein patients undergo two episodes of X-ray separated by 7 days, followed by a single MRI if clinical suspicion remains, minimising unnecessary immobilisation.
Introduction Scaphoid fractures are the commonest carpal bone fracture. If untreated they pose significant risk to patients, thus if a scaphoid fracture is suspected, patients are managed with immobilisation. Although scaphoid fractures may be difficult to diagnose on plain radiography, sometimes for months after injury, ongoing radiographic surveillance is preferred due to its low upfront cost. Patients in immobilising casts for long periods experience significant personal and social ramifications such as difficulty working and self‐caring. This study examines whether cross‐sectional imaging by computed tomography (CT) or magnetic resonance imaging (MRI) is quicker than serial X‐ray surveillance at allowing a scaphoid fracture to be either excluded or confirmed. Methods A retrospective record review was performed of the 1709 patients who presented to Royal North Shore Hospital in 2015 with wrist injuries, finding 104 patients clinically suspicious for a fractured scaphoid. Results All patients were examined by X‐ray during their initial hospital presentation, providing 33.7% of final diagnoses in 0.6 ± 1.7 days. However, if initial X‐ray proved inconclusive, subsequent serial X‐ray surveillance made a final diagnosis after a mean of 24.1 ± 17.2 days, with some being immobilised for up to 67 days before diagnosis. Cross‐sectional imaging significantly reduced diagnosis time to 9.8 ± 5.8 days (P = 0.0016), with a maximum immobilisation time of 24 days. Conclusion Cross‐sectional imaging allows for faster scaphoid fracture diagnosis than X‐ray. We propose a protocol for scaphoid fracture diagnosis wherein patients undergo two episodes of X‐ray separated by 7 days, followed by a single MRI if clinical suspicion remains, minimising unnecessary immobilisation. Delayed scaphoid fracture diagnosis is a cause of significant inconvenience to patients. This paper highlights the need for a scaphoid fracture diagnosis protocol, with patients being made to wait in immobilising casts for up to 67 days without a definitive diagnosis if X‐ray alone is used. When cross‐sectional imaging techniques are applied, a final diagnosis is reached much more rapidly, reducing the incidence of unnecessary wrist immobilisation.
Author Tsang, Venessa H.
Giuffre, Bruno
Wijetunga, Asanka R.
AuthorAffiliation 1 University of Sydney Sydney Australia
4 Department of Radiology Royal North Shore Hospital Sydney Australia
2 Department of Endocrinology Royal North Shore Hospital Sydney Australia
3 Sydney Medical School, University of Sydney Sydney Australia
AuthorAffiliation_xml – name: 1 University of Sydney Sydney Australia
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  givenname: Asanka R.
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  surname: Wijetunga
  fullname: Wijetunga, Asanka R.
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  givenname: Venessa H.
  surname: Tsang
  fullname: Tsang, Venessa H.
  organization: Sydney Medical School, University of Sydney
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  givenname: Bruno
  surname: Giuffre
  fullname: Giuffre, Bruno
  email: bruno.giuffre@health.nsw.gov.au
  organization: Royal North Shore Hospital
BackLink https://www.ncbi.nlm.nih.gov/pubmed/30160062$$D View this record in MEDLINE/PubMed
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Copyright 2018 The Authors. published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology
2018 The Authors. Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology.
2019 Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology
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– notice: 2019. This work is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.
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Issue 1
Keywords scaphoid bone
magnetic resonance imaging
Fractures
wrist injuries
X-rays
Language English
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Snippet Introduction Scaphoid fractures are the commonest carpal bone fracture. If untreated they pose significant risk to patients, thus if a scaphoid fracture is...
Scaphoid fractures are the commonest carpal bone fracture. If untreated they pose significant risk to patients, thus if a scaphoid fracture is suspected,...
IntroductionScaphoid fractures are the commonest carpal bone fracture. If untreated they pose significant risk to patients, thus if a scaphoid fracture is...
INTRODUCTIONScaphoid fractures are the commonest carpal bone fracture. If untreated they pose significant risk to patients, thus if a scaphoid fracture is...
Abstract Introduction Scaphoid fractures are the commonest carpal bone fracture. If untreated they pose significant risk to patients, thus if a scaphoid...
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StartPage 30
SubjectTerms Adolescent
Adult
Aged
Aged, 80 and over
Child
Computed tomography
Diagnosis
Female
Fractures
Fractures, Bone - diagnostic imaging
Humans
Immobilization
Magnetic Resonance Imaging
Male
Medical imaging
Middle Aged
Multimodal Imaging
NMR
Nuclear magnetic resonance
Original
Outpatient care facilities
Patients
Radiography
Retrospective Studies
Risk
scaphoid bone
Scaphoid Bone - diagnostic imaging
Scaphoid Bone - injuries
Studies
Surveillance
Tomography, X-Ray Computed
Wrist
wrist injuries
X‐rays
Young Adult
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Title The utility of cross‐sectional imaging in the management of suspected scaphoid fractures
URI https://onlinelibrary.wiley.com/doi/abs/10.1002%2Fjmrs.302
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