A virtual pathway reduced the need for physical review in patients with a suspected scaphoid fracture

Year 2019, , 8 - 13, 04.01.2019

Paul J Jenkins Stephen Boyce Pauline Garvey Kevin Bee David Shields , Lech A Rymaszewski

https://doi.org/10.18621/eurj.411396

Cited By: 2

Abstract

Objectives: Suspected scaphoid fractures
are a common reason for referral from the emergency department to fracture
clinics. Few patients actually have a fracture. Cross sectional imaging has the
potential to improve early diagnosis and reduce unneccessary immobilisation.
The aim of this audit was to investigate the effectiveness of a virtual
pathway, incorporating early magnetic resonance imaging (MRI) scan, for
suspected scaphoid fractures. The secondary aim was to investigate whether the
accuracy of other clinical signs, such as anatomical snuffbox pain on wrist
ulnar deviation, was sufficient to reduce the number of patients requiring a
MRI scan.

Methods: A prospective audit was
undertaken of 123 patients in an emergency department and associated minor
injuries unit. These patients were managed with an early MRI scan. Where no
significant injury was found, they were discharged after a phone call from a
virtual fracture clinic nurse.

Results: There were 16 (13%)
true scaphoid fractures. MRI scanning showed other injuries including significant
soft tissue injuries (13%), other carpal fractures (17%) and fractures of the
distal radius (19.5%). The number of clinical appointments required was 0.42
per patient. Eighty patients did not have any face-to-face review. Other
clinical examination techniques, such as anatomical snuff box pain on ulnar
deviation of the wrist were not sufficiently sensitive or specific to reduce
the need for MRI scanning or review.

Conclusions: A virtual fracture
clinic pathway and early MRI scanning reduced face-to-face reviews and
unneccesary immobilisation. Clinical examination techniques are not
sufficiently sensitive to reduce the need for scanning. 

Keywords

Scaphoid, fracture, virtual fracture clinic

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