Acute cross sectional imaging for suspected scaphoid fractures in adults
Date First Published:
May 18, 2009
Last Updated:
July 30, 2009
Report by:
Nicholas Morse, ST4 Emergency Medicine (Great Western Hospital, Swindon)
Search checked by:
Charlotte Kelly , Great Western Hospital, Swindon
Three-Part Question:
In [adult patients with acute anatomical snuff box tenderness] is [computed tomography better than magnetic resonance imaging] at [diagnosing fractures of the scaphoid]?
Clinical Scenario:
You see a thirty year old male colleague who has fallen on to his dominant outstretched hand. He is complaining of tenderness in his anatomical snuffbox. His scaphoid views do not show an obvious fracture, but he is reluctant to be in a splint for a fortnight. He asks you if there is any role for further imaging to rule out a fracture. You wonder whether CT would be better than MRI at diagnosing a scaphoid fracture
Search Strategy:
Medline 1980 to present day using EMBASE interface
Cochrane Library Issue 1 2009
Cochrane Library Issue 1 2009
Search Details:
EMBASE search: [exp scaphoid fracture/OR exp scaphoid injury.ti.ab] AND [EXP magnetic resonance imaging/OR computed tomography.ti.ab] Limited to human and English language
Cochrane Library search: diagnosis scaphoid fracture CT MRI
Cochrane Library search: diagnosis scaphoid fracture CT MRI
Outcome:
Two papers were found that were directly relevant to the three part question
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Occult Scaphoid Fractures: Comparison of Multidetector CT and MR Imaging - Initial Experience Memarsadeghi M, Breitensher M, Schaefer-Prokop C, Weber M, Aldrian S, Gabler C, Prokop M 2006 Austria | 29 patients with acute scaphoid pain after trauma | Prospective diagnostic study | Diagnosis of occult fracture | No statistical difference between CT and MRI for detection of scaphoid fractures (p=0.25). CT better at detecting cortical involvement (p=0.03) | Small study size |
| Diagnosis of occult scaphoid fracture: a comparison of magnetic resonance imging and computed tomography techniques Kusano N, Churei Y, Shiraishi E, Kusano T 2002 Japan | 52 adult patients with suspected scaphoid fracture after trauma | Prospective diagnostic study | Diagnosis of occult fracture | 100% sensitivity with both CT and MRI | Small study size Not all patients with a fracture detected on MRI had a CT (16/18) |
Author Commentary:
One paper shows that CT is statistically significantly better than MRI at diagnosing cortical involvement, but is not significantly better at overall diagnosis of occult scaphoid fracture. Both CT and MRI are useful tools for diagnosis of occult scaphoid fracture. CT is quicker to perform, and is more likely to be readily available.
Bottom Line:
There is no evidence to suggest that CT is better than MRI at the overall diagnosis of occult scaphoid fractures.
Level of Evidence:
Level 3: Small numbers of small studies or great heterogeneity or very different population
References:
- Memarsadeghi M, Breitensher M, Schaefer-Prokop C, Weber M, Aldrian S, Gabler C, Prokop M. Occult Scaphoid Fractures: Comparison of Multidetector CT and MR Imaging - Initial Experience
- Kusano N, Churei Y, Shiraishi E, Kusano T. Diagnosis of occult scaphoid fracture: a comparison of magnetic resonance imging and computed tomography techniques