title: Does scaphoid bone bruising lead to occult fracture? A prospective study of 50 patients.
abstract: BACKGROUND
  Bone bruising of the scaphoid is a term reported when magnetic resonance imaging (MRI) is carried out for scaphoid injury. The aim of our study was twofold: to see if bone bruising alone without fracture of the scaphoid bone seen on initial MRI, in a clinically symptomatic (tender) patient at 10-14 days, progressed to fracture, and to define how this entity of bone bruising should be managed.
  
  
  METHODS
  This was a prospective study looking at 170 patients with scaphoid injuries, of which 50 had bone bruising without fracture. These were followed up for at least 8 weeks to ascertain whether or not they had developed a fracture. They were assessed for continuity or resolution of their symptoms by way of clinical examination and/or a further MRI and X-ray (scaphoid views).
  
  
  RESULTS
  Of the 170 scaphoid injuries identified, there were 120 scaphoid fractures seen on scaphoid view radiographs. The remaining 50 were clinically symptomatic and had MRI scaphoid imaging, which demonstrated various grades of bone bruising. All were treated in a scaphoid plaster, and re-examined at 8 weeks. There were four patients who remained symptomatic, for whom MRI scans were performed, which revealed all four with resolving scaphoid bone bruising, and one with a scaphoid fracture (p value=0.0386). Incidentally, 2 further weeks of immobilisation resolved the symptoms of those four patients. The one patient with a fracture was offered further treatment for the risk of progressing to a nonunion.
  
  
  CONCLUSIONS
  Bone bruising detected on MRI without fracture is an important entity, and can lead to occult fracture (2%). It can take anywhere up to 8 weeks to declare. Treatment for bone bruising should be with a scaphoid cast and follow-up X-ray.
authors.affiliation: CT3 Trauma and Orthopaedics, Department of Trauma and Orthopaedics, The Royal Berkshire Hospital, London Road, Reading RG1 1AN, UK. dushanthavarajah@yahoo.com
authors.forename: Dushan
authors.initials: D
authors.lastname: Thavarajah
authors.forename: Turab
authors.initials: T
authors.lastname: Syed
authors.forename: Yousef
authors.initials: Y
authors.lastname: Shah
authors.forename: Martin
authors.initials: M
authors.lastname: Wetherill
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001853:Bone Marrow / Q000293:injuries; D002370:Casts, Surgical; D002648:Child; D003288:Contusions / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D018450:Disease Progression; D004487:Edema / Q000150:complications; D005260:Female; D005596:Fractures, Closed / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D012720:Severity of Illness Index; D055815:Young Adult