title: Role of MRI in the diagnosis and management of patients with clinical scaphoid fracture.
abstract: OBJECTIVE
  The American College of Radiologists (ACR) recognises the value of magnetic resonance imaging (MRI) as the investigation of choice in patients with a clinically suspected scaphoid fracture but normal plain radiographs. The Royal College of Radiologists (RCR) in the UK produces no similar guidelines, as evidenced by the inconsistent management of such cases in hospitals around the UK. In discussion with our musculoskeletal radiologists, we implemented new guidelines to standardise management of our patients and now report our findings.
  
  
  METHODS
  A consecutive series of 137 patients referred to the orthopaedic department with clinically suspected scaphoid fracture but normal series of plain radiographs were prospectively followed up over a two-year period. We implemented the use of early MRI for these patients and determined its incidence of detected scaphoid injury in addition to other occult injuries. We then prospectively examined results of these findings on patient management.
  
  
  RESULTS
  Thirty-seven (27%) MRI examinations were normal with no evidence of a bony or soft-tissue injury. Soft-tissue injury was diagnosed in 59 patients (43.4%). Of those, 46 were triangular fibrocartilage complex (TFCC) tears (33.8%) and 18 were intercarpal ligament injuries (13.2 %). Bone marrow oedema with no distinct fracture was discovered in 55 cases (40.4%). In 17 (12.5%) cases, this involved only the scaphoid. In the remainder, it also involved the other carpal bones or distal radius. Fracture(s) were diagnosed on 30 examinations (22.0%).
  
  
  CONCLUSIONS
  MRI should be regarded as the gold standard investigation for patients in whom a scaphoid fracture is suspected clinically. It allows the diagnosis of occult bony and soft-tissue injuries that can present clinically as a scaphoid fracture; it also helps exclude patients with no fracture. We believe that there is a need to implement national guidelines for managing occult scaphoid fractures.
authors: Department of Trauma & Orthopaedics, Barts & The London NHS Trust, 59 Elmstead Lane, Chislehurst Kent BR7 5EQ, UK. Sak11@hotmail.com
authors: Saket
authors: S
authors: Tibrewal
authors: Prakash
authors: P
authors: Jayakumar
authors: Sujit
authors: S
authors: Vaidya
authors: Swee Chai
authors: SC
authors: Ang
mesh_terms: D000328:Adult; D005260:Female; D005592:Fracture Fixation / Q000379:methods; D050723:Fractures, Bone / Q000175:diagnosis* / Q000628:therapy; D005596:Fractures, Closed / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods* / Q000592:standards; D008297:Male; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D021361:Scaphoid Bone / Q000293:injuries* / Q000473:pathology; D017695:Soft Tissue Injuries / Q000175:diagnosis / Q000628:therapy; D014954:Wrist Injuries / Q000175:diagnosis* / Q000628:therapy