title: Survey of the initial management and imaging protocols for occult scaphoid fractures in UK hospitals.
abstract: OBJECTIVE
  The aim of this research was to survey how occult fractures of the scaphoid bone are both imaged and managed initially.
  
  
  METHODS
  A total of 832 questionnaires were sent via e-mail to active associate members of the British Orthopaedic Association. Included was a series of questions regarding the timing of initial and subsequent orthopaedic review of this group of patients and the use of serial radiographs and second-line imaging techniques.
  
  
  RESULTS
  Nearly half of the UK's acute NHS trusts were represented (45%). The response rate was 16% (130 out of 832). Only 16% of respondents were aware of a local imaging protocol for the investigation of suspected fractures of the scaphoid. Ninety-four percent of respondents performed a second radiograph at first fracture clinic review. Fifty-eight percent used magnetic resonance imaging (MRI) as a second-line investigation; with computed tomography scan and radionuclide isotope bone scan being performed by 26% and 16% respondents, respectively.
  
  
  CONCLUSIONS
  The survey revealed a wide variation in the management of occult fractures of the scaphoid. MRI has been shown to be both sensitive and specific in diagnosing occult carpal bone fractures. There is a need to standardise the management of these injuries to ensure early diagnosis and limit unnecessary wrist immobilisation.
authors.affiliation: Department of Trauma and Orthopaedics, Countess of Chester Hospital NHS Foundation Trust, Countess of Chester Health Park, Chester, UK. sbrookesfazakerley@yahoo.co.uk
authors.forename: S D
authors.initials: SD
authors.lastname: Brookes-Fazakerley
authors.forename: A J Shyam
authors.initials: AJ
authors.lastname: Kumar
authors.forename: J
authors.initials: J
authors.lastname: Oakley
mesh_terms: D005260:Female; D005596:Fractures, Closed / Q000175:diagnosis* / Q000453:epidemiology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D006113:United Kingdom / Q000453:epidemiology; D014954:Wrist Injuries / Q000175:diagnosis / Q000453:epidemiology