Pilot Study to Test the Feasibility of the Use of MRI in Suspected Scaphoid Fractures
Scaphoid Fracture
About this trial
This is an interventional diagnostic trial for Scaphoid Fracture focused on measuring suspected scaphoid fracture
Eligibility Criteria
Inclusion Criteria:
- Patients considered to be suitable for the proposed pathway include every patient aged 16 years old or above, presenting at A&E/UCC between 8:00am and 4:00pm (Monday to Friday), with at least one of the following:
- Isolated pain / tenderness over the Anatomical Snuff Box (ASB) or scaphoid tubercle or pain in the scaphoid region during axial loading of the 1st metacarpal.
- History of recent fall (< 14 days) on out-stretched hand (FOOSH), wrist injury or poor history associated with examination findings suggestive of scaphoid fracture.
Exclusion Criteria:
- Patients presenting outside GSTT's catchment area not willing to be followed-up at GSTT;
- Patients without suspected scaphoid fracture following an initial A&E/UCC clinical triage;
- Patients with scaphoid fracture not admitted through A&E at St Thomas' Hospital or Urgent Care Centre at Guy's Hospital;
- Patients presenting at ED/UCC on weekdays (Monday to Friday) before 8:00am or after 4:00pm
- Patients presenting at ED/UCC on weekends or Bank Holidays;
- Patients who lack capacity to give consent or participate in the study;
- Patients that are already taking part in a clinical trial of an investigational medicinal products (CTIMPs);
- Patient is unable or unsuitable to MRI
Sites / Locations
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
MRI group
X-ray group
This arm assess the use of MRI as the first line examination of suspected scaphoid fracture (replacing conventional plain x-ray). Patients with negative findings will receive a splint and contact card to a specialist wrist clinic if the pain persists for ten to fourteen days after initial presentation. Patients with positive findings will receive a plaster cast and undergo a CT scan (to evaluate displacement) and will be referred to the fracture clinic. Furthermore, if the CT scan confirms a displaced fracture, that might require surgery, the patient should be seen by a Hand Specialist at fracture clinic. All patients enrolled in the pilot should undergo a 4-view plain x-ray 3 months after the initial ED/UCC presentation.
This arm is the current standard of care pathway for the diagnosis of patients with suspected scaphoid fracture. This includes an initial clinical assessment on arrival to the Emergency Department of Urgent Care Centre followed by a plain x-ray (using a 4-view scaphoid protocol). Patients with negative/positive findings for scaphoid fracture in the initial X-ray will be immobilised with a splint/plaster cast. All patients will be referred to an initial fracture clinic and a proportion of patients are likely to require additional imaging scans (usually CT but also MRI) and follow-up appointments in the fracture clinic. All patients enrolled in the pilot should undergo a 4-view plain x-ray 3 months after the initial ED/UCC presentation.