Early MRI in the management of 'clinically suspected scaphoid fractures'.

Abstract

Clinically suspected scaphoid fractures tend to be occult (20- 25%) and generally are missed upon plain radiographs taken immediately post- trauma Therefore, clinicians tend to, ' ... over- treat a lot of patients to avoid under treating a few' . Many patients, therefore, undergo the discomfort of having their wrist in a cast for several weeks unnecessarily. Furthermore, the fracture may not be visible on a radiograph until 10 to 14 days after the injury, when callus formation starts to occur. In such cases, MRI should be the ideal imaging modality. As it has been proved to have 1 00% sensitivity and specificity in such cases and hence is said to be the gold- standard imaging modality The above, compelled the MRI team at St. Luke's Hospital to offer such a service. An MRI short wrist imaging protocol was set up, and patient selection protocols were drawn up by the Orthopaedic specialist. This research study looked into the running of this service and its outcomes on patient treatment and the day- to- day practicalities of it. In 75% of the cases, treatment of the patient was altered after an early MRI scan. MRI examinations were done 2.83 days post- trauma on average and reports were issued 3.6 days post- MRI scan. The duration of the MRI examination took 20 minutes on average. This study showed that an early MRI scan significantly alter the treatment of 'the most expensive bone in the human body'