Year 2019, Volume 5, Issue 1, Pages 8 - 13 2019-01-04

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

Paul J Jenkins [1] , Stephen Boyce [2] , Pauline Garvey [3] , Kevin Bee [4] , David Shields [5] , Lech A Rymaszewski [6]

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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. 

Scaphoid, fracture, virtual fracture clinic
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Primary Language en
Subjects Health Care Sciences and Services
Journal Section Original Articles
Authors

Orcid: 0000-0003-1175-0205
Author: Paul J Jenkins
Institution: Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
Country: United Kingdom


Orcid: 0000-0003-3866-1851
Author: Stephen Boyce
Institution: Department of Emergency Medicine, Glasgow Royal Infirmary, Glasgow, United Kingdom
Country: United Kingdom


Orcid: 0000-0002-7570-8965
Author: Pauline Garvey
Institution: Department of Emergency Medicine, Glasgow Royal Infirmary, Glasgow, United Kingdom
Country: United Kingdom


Orcid: 0000-0002-0624-6955
Author: Kevin Bee
Institution: Department of Dentistry & Nursing, University of Glasgow, School of Medicine, Glasgow, United Kingdom
Country: United Kingdom


Orcid: 0000-0003-4663-778X
Author: David Shields (Primary Author)
Institution: Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
Country: United Kingdom


Orcid: 0000-0003-3064-8337
Author: Lech A Rymaszewski
Institution: Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
Country: United Kingdom


Dates

Publication Date: January 4, 2019

EndNote %0 The European Research Journal A virtual pathway reduced the need for physical review in patients with a suspected scaphoid fracture %A Paul J Jenkins , Stephen Boyce , Pauline Garvey , Kevin Bee , David Shields , Lech A Rymaszewski %T A virtual pathway reduced the need for physical review in patients with a suspected scaphoid fracture %D 2019 %J The European Research Journal %P -2149-3189 %V 5 %N 1 %R doi: 10.18621/eurj.411396 %U 10.18621/eurj.411396