Abstract
Aim
To determine if the instigation of Magnetic Resonance Extremity (MRE) scanning in our unit as part of the management of suspected paediatric scaphoid fractures has prevented overuse of splints or casts reduced unnecessary clinic appointments and saved our department financially.
Methods
Children with traumatic anatomical snuffbox tenderness and negative radiographs are seen 10 days following injury having been given a Futura® splint. If repeat radiographs are negative with on-going positive clinical findings the child has an MRE scan, which is usually reported the same day. If negative, the splint is removed on that day, but if positive, a cast is applied and the child referred onto paediatric fracture clinic.
Results
Over a one-year period, 65 acute injuries were referred for MRE scanning. Fourteen bony injuries (22%) were identified including 10 scaphoid, 1 capitate and 3 distal radius fractures. The delay until MRE scanning averaged 11 days from emergency department and 14 days from outpatient clinic. Of these positive cases, the average time to clinic was 15 days equating to an average of 5 weeks from injury to orthopaedic review. The saving of orthopaedic clinics offsets the cost of the MRE scan by £5000 per annum. Fractures were identified in 22% of patients referred for MRE scanning with normal radiographs.
Conclusion
The practice of streamlined MRE scanning for suspected paediatric scaphoid fractures can tailor management more efficiently. It has reduced the length of immobilisation in those normal cases and eradicated the need for continuing orthopaedic clinic review without increasing costs.
