Survey of the initial management and imaging protocols for occult scaphoid fractures in UK hospitals.
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.
Brookes-Fazakerley
S D
SD
Department of Trauma and Orthopaedics, Countess of Chester Hospital NHS Foundation Trust, Countess of Chester Health Park, Chester, UK. sbrookesfazakerley@yahoo.co.uk
Kumar
A J Shyam
AJ
Oakley
J
J
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