Scaphoid Fractures

Hand injury is a common presentation to A&E departments in the UK. Out of patients presenting with wrist pain and tenderness, at least two thirds will be found to have no fractures. Of the remaining patients, most do not present with an obvious scaphoid fracture. Furthermore, depending on the imaging modality used, scaphoid fractures might not be evident at time of presentation.

Definitive diagnosis of scaphoid fractures is challenging, and various clinical complications may arise from a misdiagnosed scaphoid fracture.

TOHETI will assess the use of MRI as an additional imaging technique to X-ray scans, in order to allow earlier, definitive diagnosis.

All patients with suspected scaphoid fracture that enter A&E/UCC will undergo x-ray as the initial imaging test to assess their potential injury. Following that, patients with: (i) findings suggestive of scaphoid fracture will receive immediate treatment and will not be included in the study; whilst (ii) patients with no findings suggestive of scaphoid fracture, will be invited to take part in the study.

Proposed benefits

  • Improves the diagnostic pathway for suspected scaphoid fractures, by providing an early and accurate diagnosis and, subsequently, appropriate and timely treatment
  • Eliminates over-diagnosis, to remove inconvenience caused by unnecessary immobilisation of patients who do not have a fractured scaphoid
  • Cost of additional MRI scan predicted to be offset by savings made in decreasing the amount of unnecessary diagnostic and treatment procedures

A two month pilot was completed in January 2016 to test the study feasibility in an busy emergency care setting, and to provide an opportunity for staff to test and feedback on processes. This led to modifications in the study design for main study. Main scaphoid study recruited 136 patients between 2016-2018. Currently TOHETI team is analysing patients’ data and aim to share results of the study before end of 2018.

Ahead of the study, training in conducting research and obtaining informed consent was also delivered for Emergency Nurse Practitioners and radiographers involved in the study.

  • “This is a great opportunity to change the discourse around the most effective and accurate way of imaging patients with suspected scaphoid fractures, when they first attend A&E, and thereby significantly improve the quality of patient care” Sam Gidwani, Consultant Orthopaedic Hand Surgeon, Chief Investigator TOHETI Scaphoid Research Pathway