Abstract
Introduction
Up to 16% of scaphoid fractures are radiologically occult; failure to diagnose scaphoid fractures may lead to delayed union, nonunion or avascular necrosis. Fractures may take weeks to be excluded and many patients are unnecessarily immobilised increasing work absence, clinical reviews and cost. The use of CT early in the management of suspected occult scaphoid fractures has been evaluated.
Methods
The radiology and clinical notes of all patients that had scaphoid CT scans over the preceding 3 years were retrospectively reviewed. 84 patients that had CT scans within 14 days from injury were identified.
Results
64% of CTs excluded fracture (N=54) and these patients were mobilised promptly and reviewed within six weeks. No patients returned with any complications, such as carpal instability, from this management strategy. Mean number of clinic appointments for this group was 2.34 (range 2–6). 36% of CTs were abnormal (N=30). 7% revealed occult scaphoid fractures; 18% revealed occult carpal fractures of the triquetrum, capitate and lunate respectively and 5% distal radius fractures. All patients diagnosed with fractures were successfully managed with plaster immobilisation, with one case of regional pain syndrome.
Conclusions
Early CT immediately alters therapeutic decision making in suspected occult fractures preventing unnecessary immobilisation. Early CT also reduces clinic attendances for clinical and radiological review without increase in cost.
