[Variations in management of suspected scaphoid fractures].
OBJECTIVE
This study evaluated the daily clinical practice for management of patients with suspected scaphoid fractures in hospitals in the Netherlands and compared it with recommendations from the current literature.


METHODS
Questionnaire-based investigation.


METHODS
Doctors working in emergency departments in hospitals in the Netherlands were asked to complete an 8-question survey including questions on diagnostic strategies, treatment type and the time between different steps in the management policy.


RESULTS
Doctors from 90 of the 100 hospitals approached completed the questionnaire. A total of 71 of these 90 hospitals had an established protocol. In the other 19 it depended on the preference of the treating doctor. In 75 hospitals a follow-up outpatient clinic appointment was made for within 10 days. In 70 hospitals X-rays were repeated before additional imaging investigation. CT was the most frequently used additional investigation in 35 hospitals, followed by bone scintigraphy (12) and MRI (2). No additional investigation was carried out in 11 hospitals and when X-rays showed no abnormalities treatment was implemented on the basis of clinical evaluation. In 72 hospitals the wrist was immobilised with a lower-arm plaster cast including the thumb. Lower-arm plaster cast not including the thumb was used in 1 hospital.


CONCLUSIONS
There is a great deal of variation in diagnosis and treatment of patients with a suspected scaphoid fracture within hospitals in the Netherlands. Furthermore, management policy in most hospitals is not in keeping with the most recent recommendations. Evidence-based guidelines are required in order to limit over-diagnosis and unnecessary immobilisation.
Academisch Medisch Centrum, Afd. Orthopedie, Amsterdam, the Netherlands. w.h.mallee@amc.uva.nl
Wouter H
WH
Mallee
Ewout S
ES
Veltman
Job N
JN
Doornberg
Leendert
L
Blankevoort
C Niek
CN
van Dijk
J Carel
JC
Goslings
D002370:Casts, Surgical; D019317:Evidence-Based Medicine; D050723:Fractures, Bone / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008505:Medical Staff, Hospital / Q000523:psychology* / Q000592:standards / Q000706:statistics & numerical data; D009426:Netherlands; D019637:Orthopedic Procedures / Q000379:methods / Q000592:standards*; D017410:Practice Guidelines as Topic; D021361:Scaphoid Bone / Q000293:injuries*; D016896:Treatment Outcome