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

Authors : Paul J JENKİNS, Stephen BOYCE, Pauline GARVEY, Kevin BEE, David SHİELDS, Lech A RYMASZEWSKİ

Pages : 8-13

Doi:10.18621/eurj.411396

View : 14 | Download : 9

Publication Date : 2019-01-04

Article Type : Research Paper

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 insert ignore into journalissuearticles values(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 insert ignore into journalissuearticles values(13%); true scaphoid fractures. MRI scanning showed other injuries including significant soft tissue injuries insert ignore into journalissuearticles values(13%);, other carpal fractures insert ignore into journalissuearticles values(17%); and fractures of the distal radius insert ignore into journalissuearticles values(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