gms | German Medical Science

Objectives/Interrogation: MRI has been shown to have high specificity and sensitivity in detecting occult wrist fractures. However it is more expensive and less widely available than CT scan. For patients with suspected scaphoid fracture, our practice is to use CT imaging. We invited patients with clinical suspicion of scaphoid fracture, but normal X-rays and CT to come for an MRI scan. Our aim was to identify those with MRI evidence of scaphoid fracture or other occult injury and thus demonstrate whether our current clinical pathway misses significant pathology

Methods: Patients were reviewed 10-14 days after their initial injury. If there was ongoing clinical suspicion of a scaphoid fracture, repeat radiographs were performed. Those with normal radiographs but ongoing pain had a CT scan. Those with normal CT scans were invited back for an MRI scan. These patients also completed functional and pain scores at the time of assessment and 6 months post-injury.

Results and Conclusions: 100 patients were studied. 14 fractures were discovered in 13 patients:

• Scaphoid - 6
• Scaphoid plus capitate - 1
• Capitate - 1
• Lunate - 1
• Trapezium - 2
• Distal radius - 2
• Another patient had an SL tear, one had marked arthritis and 15 further patients showed equivocal findings with bone bruising or significant fluid.

Summary: Our results demonstrate that a significant proportion of patients with normal X-rays and CT scan have a scaphoid fracture, an alternative occult fracture, or other finding that might need intervention. These would not have been detected by our current pathway. The study shows that radiographs and CT scans fail to detect significant numbers of occult wrist injuries that are detectable on MRI scan.