Magnetic resonance imaging of suspected scaphoid fractures
Date First Published:
April 12, 2005
Last Updated:
April 12, 2005
Report by:
Peter Speake, House Officer (Manchester Royal Infirmary)
Search checked by:
A Lama, Manchester Royal Infirmary
Three-Part Question:
In [suspected scaphoid fractures] is [magnetic resonance imaging] a realistic modality if [plain radiographs do not identify a fracture]
Clinical Scenario:
A patient attends the emergency department with pain in keeping with a fractured scaphoid. The standard scaphoid views failed to identify a fracture. Should magnetic resonance imaging be conducted or is it too expensive.
Search Strategy:
Medline 1966 until April 2005
Search Details:
(fracture$.af. OR exp Fractures, Comminuted/ OR exp Fractures, Closed/ OR exp Fractures/ OR exp Fractures, Ununited/ OR exp Fractures, Malunited/) AND (exp Magnetic Resonance Imaging? OR (magnet$ ADJ reson$ ADJ imag$).mp. OR mri.af. OR Magnetic Resonance Spectroscopy? OR (magnet$ ADJ reson$ ADJ spect$).mp. OR nmr.af. AND (Scaphoid Bone? OR scaphoid.af. OR scaphoid$).
Limited to humans and english
Limited to humans and english
Outcome:
143 papers were identified in medline, three of these were relevant to the three part question.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Magnetic Resonance Imaging of Suspected Scaphoid Fractures Using a Low Field Dedicated Extremity MR System Raby N. 2001 UK | 53 patients late MRI 56 patients early MRI (extremity MRI) |
PRCT | Acute injury detected on MRI, Cost effective and changed patient management | early MRI changed management in 89% of patients. Late MRI changed management in 69% of patients. Early MRI more cost effective | Poor follow up of discharged patients Patients not randomly allocated Doesn't describe criteria used to diagnose scaphoid fractures |
| Early MRI in the management of clinical scaphoid fracture Brydie A. and Raby N. 2003 UK | 195 patients with 14 day acute injury | CT | Detected injury to wrist. Cost and change in patient management | 51% normal. 38% fracture identified (19% scaphoid). 92% change in patient management. MRI no more expensive than previous protocol. | No follow up of discharged patients with negative MRI scan |
| Magnetic Resonance Imaging of Occult Scaphoid Fractures Gaebler C., Kukla C., Breitenseher M., Trettnig S., Mittboeck M. and Vecsei V. 1996 Austria | 32 patients with MRI scan in less than 6 days post injury | PRCT | Cost and detection of injury | MRI detected all fractures earlier than plain x-rays. Saving of $7,200 per 100,000 inhabitants | Small study |
Author Commentary:
The evidence suggests that MRI scanning is a cost effective alternative to the protocols used currently in the emergency department. More importantly it has demonstrated that it significantly alters patients management. However the limiting factor will probably be the availability of the scanners to conduct such tests.
Bottom Line:
Early MRI scanning is a cost effective procedure when a scaphoid fracture is suspected and plain radiographs fail to identify the injury. It also has a large effect on the subsequent management of the patient.
References:
- Raby N.. Magnetic Resonance Imaging of Suspected Scaphoid Fractures Using a Low Field Dedicated Extremity MR System
- Brydie A. and Raby N.. Early MRI in the management of clinical scaphoid fracture
- Gaebler C., Kukla C., Breitenseher M., Trettnig S., Mittboeck M. and Vecsei V.. Magnetic Resonance Imaging of Occult Scaphoid Fractures