Emerg Med J 27:266-269 doi:10.1136/emj.2008.058750
  • Original Article

Role of MRI in the diagnosis of clinically suspected scaphoid fracture: analysis of 611 consecutive cases and literature review

  1. Russell Walker
  1. Nevill Hall Hospital, Abergavenny, UK
  1. Correspondence to Mr M Khalid, 14 Portway, Didcot, Oxfordshire OX11 0BE, UK; Khalidbones{at}
  • Accepted 15 December 2008


Background A clinically suspected scaphoid fracture with normal initial plain x-rays is a difficult but common problem. The role of MRI as a diagnostic modality in this situation was analysed based on the experience of 611 consecutive cases.

Methods All patients presenting to the emergency department with a history of a fall on an outstretched hand and with tenderness over the anatomical snuff box and scaphoid tubercle but normal plain x-rays were offered MRI as part of the standard protocol. Between January 2003 and November 2005, 611 of a total of 619 such patients underwent the scan and form the study cohort. Coronal 3 mm T1 and Short Tau Inversion Recovery images were obtained using a 12 cm field of view as standard.

Results There were 342 abnormal scans (56%) and 269 (44%) normal scans. Of the abnormal scans, 80% showed acute bony injuries, 8% showed acute soft tissue injuries and 12% showed incidental pathology.

Conclusions MRI is a useful and effective tool in the diagnosis of radiologically occult wrist injuries. It is feasible to do MRI scans in a timely manner in a district general hospital.


  • Competing interests No conflict of interest declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.