Suspected Scaphoid Fractures Investigated with Limited Sequence Wrist MRI Scans: A Prospective Cohort Study

Background: Patients with wrist injuries presenting to the emergency department (ED) are commonly managed as suspected scaphoid fractures. Resources for timely standard wrist magnetic resonance imaging (MRI) scans can be insufficient. This study aimed to evaluate the effectiveness of limited sequence wrist MRI scans in diagnosing suspected scaphoid fractures in patients with negative initial radiographs. Methods: A prospective, single-centre study comprising 279 consecutive wrists with suspected scaphoid fractures with initially negative radiographic findings. Patients were reviewed in fracture clinic 10-14 days post injury. If anatomical snuffbox, scaphoid tubercle tenderness or pain on axial loading of the thumb were present, a limited sequence wrist MRI scan was requested. Results: Median time from injury to ED presentation was 1 day, injury to MRI scan was 15 days and a follow-up appointment with scan result was 21 days. The MRI scans showed 47 (17%) scaphoid fractures, 66 (24%) fractures of another bone and 150 (54%) soft tissue injuries. A total of 73 (26%) scans reported no abnormalities. The sensitivity for tenderness at the anatomical snuff box was 91%, at the scaphoid tubercle was 81% and pain on the thumb axial grind test was 49%. Following their MRI scan, 41% of patients were discharged from the clinic. Six (2%) patients had operations, with four percutaneous scaphoid fixations, one EPL tendon reconstruction and one scapholunate ligament repair. Conclusions: Early limited sequence wrist MRI scans facilitate timely and effective management of suspected scaphoid fractures, thus reducing patient morbidity from missed fractures or unnecessary prolonged immobilisation. Level of Evidence: Level II (Diagnostic).