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Survey of the initial management and imaging protocols for occult scaphoid fractures in UK hospitals
S D Brookes-Fazakerley1, A J Shyam Kumar, J Oakley
1Department of Trauma and Orthopaedics, Countess of Chester Hospital NHS Foundation Trust, Countess of Chester Health Park, Chester, UK. sbrookesfazakerley@yahoo.co.uk
Objective:
The aim of this research was to survey how occult fractures of the scaphoid bone are both imaged and managed initially.
Materials And Methods:
A total of 832 questionnaires were sent via e-mail to active associate members of the British Orthopaedic Association. Included was a series of questions regarding the timing of initial and subsequent orthopaedic review of this group of patients and the use of serial radiographs and second-line imaging techniques.
Results:
Nearly half of the UK's acute NHS trusts were represented (45%). The response rate was 16% (130 out of 832). Only 16% of respondents were aware of a local imaging protocol for the investigation of suspected fractures of the scaphoid. Ninety-four percent of respondents performed a second radiograph at first fracture clinic review. Fifty-eight percent used magnetic resonance imaging (MRI) as a second-line investigation; with computed tomography scan and radionuclide isotope bone scan being performed by 26% and 16% respondents, respectively.
Conclusions:
The survey revealed a wide variation in the management of occult fractures of the scaphoid. MRI has been shown to be both sensitive and specific in diagnosing occult carpal bone fractures. There is a need to standardise the management of these injuries to ensure early diagnosis and limit unnecessary wrist immobilisation.
