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EARLY MRI FOR CLINICAL SCAPHOID FRACTURES IN CHILDREN; A BETTER PATIENT JOURNEY? A 12 YEAR REVIEW FROM BIRMINGHAM CHILDREN'S HOSPITAL
  1. B Cantonsmith,
  2. B Stanhope
  1. Emergency Department, Birmingham Children's Hospital, Birmingham, West Midlands, United Kingdom

Abstract

Objectives & Background Traditional management of Clinical Scaphoid Fractures has been to immobilise the wrist for 10–21 days and then reassess the injury. Birmingham Children's Hospital (BCH) has offered an Early MRI service for these patients for 12 years. The aim is to MRI the wrist within a few days of injury to get a definitive diagnosis and reduce unnecessary immobilisation. The objective of this review of the Early MRI service, was to analyse:

  • Age, Sex and Hand dominance

  • Percentage of actual scaphoid fractures & other carpal/radial fractures

  • Time from presentation to MRI scan

Methods Data was retrieved for all patients (aged 0–18 years) who had had a Scaphoid Xray or MRI from January 1999 until March 2012 from the Xray reporting system. Patients were included if they had presented to the Emergency Department at BCH, and had normal Scaphoid Xrays followed by an MRI scan.

Results 137 patients were included. Boys were significantly more likely to actually have a scaphoid fracture (p<0.001) even though the sex distribution of Clinical Scaphoid Fractures was equal. 22.6% had a fractured scaphoid, 18.6% fractured other carpals, 7.3% a fractured radius, 29.1% had another diagnosis and 22.6% were normal. Time from presentation until MRI scan ranged from 1–54 days with a mode of 3 days, median 11 days and mean of 14 days.

Conclusion It is possible to offer Early MRI scanning for Clinical Scaphoid Fractures, and most commonly our patients waited 3 days, reducing the length of immobilisation. A large number of other injuries were identified which were missed on initial Xrays. Half of all subjects have a fracture, however only half of these were scaphoid fractures. Only approximately a quarter of scans were normal, and therefore immobilised unnecessarily. Boys are more likely to actually have a scaphoid fracture on MRI than girls.

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