Variation in definitions of scaphoid fracture on MRI scans for suspected fracture: a systematic review

We conducted a systematic review of the definition of a scaphoid fracture on MRI scans, examining 58 studies of patients with suspected scaphoid fractures. Nearly half the studies did not report any definition or measurement of fracture. Among those that did, 29 out of 33 studies (88%) described a linear fracture shape, 13 out of 33 studies (39%) reported the extent of the fracture across the scaphoid and none specified the fracture line orientation. Of the 25 studies describing fractures using at least one of the shape and extent groupings, 12 (48%) regarded a linear signal through the cortex as a fracture, five (20%) regarded a linear intramedullary signal in isolation as a fracture and eight (32%) regarded a diffuse intramedullary signal in isolation as a fracture. This review highlights the need for a consensus definition of scaphoid fractures on MRI scans to assess the reliability and diagnostic performance of MRI scans for diagnosing true scaphoid fractures, as well as their potential harms and benefits.Systematic Review (Level III).