The Role of Radiology in Diagnosis and Management of Scaphoid Fracture

Background: This study focused on introducing MRI into the diagnostic pathway for suspected scaphoid fracture management. In discussion with our musculoskeletal radiologists, we implemented new guidelines to standardize management of our patients with scaphoid fracture and now report our findings. Materials and methods: A consecutive series of 104 patients referred to the orthopedic department with clinically suspected scaphoid fracture but normal series of plain radiographs were prospectively followed up over a three-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: 25 (24%) MRI examinations were normal with no evidence of a bony or soft-tissue injury. Soft-tissue injury was diagnosed in 45 patients (43.3%). Of those, 32 (30.8%) were triangular fibro cartilage complex (TFCC) tears and 13 (12.5%) were intercarpal ligament injuries. Bone marrow oedema with no distinct fracture was discovered in 35 (33.6%) cases. In 12 (11.5%) cases, this involved only the scaphoid. In the remainder, it also involved the other carpal bones or distal radius. Fracture(s) were diagnosed on 27 examinations (25.9%). Conclusion: 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.