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18-09-2011 | Radiology | Article

MRI best for occult scaphoid injury care


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MedWire News: Magnetic resonance imaging (MRI) should be considered the "gold standard" for imaging patients suspected of having a scaphoid fracture that is not visible on plain radiographs, research suggests.

MRI revealed scaphoid fractures in a fifth of patients who had no evidence of fracture on plain radiographs, and soft tissue damage in almost half, say Saket Tibrewal (Barts & The London NHS Trust, Chislehurst) and co-investigators.

Although the American College of Radiologists recommends MRI for patients with clinically suspected scaphoid fracture despite normal plain radiographs, the Royal College of Radiologists in the UK has yet to make such guidelines, the team observes.

To investigate, the researchers examined 137 patients attending an orthopedic department with clinically suspected scaphoid fracture with clear plain radiographs using MRI and followed-up the group for 2 years.

Just 27% of MRIs showed no bony or soft tissue injury, they report in the journal International Orthopaedics.

Scaphoid fractures were found in 11.7% of patients, two of whom also had other carpal bone fractures, while fractures of the carpal bones or distant radius were detected in 10.3%.

In addition, bone marrow edema without fracture was present in 40.4% of patients. Of these patients, 12.5% were affected only in the scaphoid, and the remainder also had edema in the carpal bones or distant radius.

Furthermore, soft tissue damage was identified in 43.4% of patients. This included triangular fibrocartilage complex tears in 33.8% and intercarpal ligament damage in 13.2%.

Patients with fracture or soft tissue injury were immobilized as appropriate and followed-up at the clinic. Ten patients with triangular fibrocartilage complex tears were later referred for specialist care.

Tibrewal et al therefore conclude that MRI "allows the diagnosis of occult bony and soft tissues injuries that can present clinically as a scaphoid fracture in addition to excluding patients with no fracture."

"This ensures that appropriate management can be implemented and thus prevent over- and undertreatment."

They add: "We believe there is a need to implement national guidelines for managing occult scaphoid fractures."

By Lynda Williams

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