Role of MRI in the Diagnosis of Clinically Suspected Scaphoid Fracture: Analysis of 611 Consecutive Cases and Literature Review

Background: A clinically suspected scaphoid fracture with normal initial plain x-rays is a difficult but common problem. The role of MRI as a diagnostic modality in this situation was analysed based on the experience of 611 consecutive cases.

Methods: All patients presenting to the emergency department with a history of a fall on an outstretched hand and with tenderness over the anatomical snuff box and scaphoid tubercle but normal plain x-rays were offered MRI as part of the standard protocol. Between January 2003 and November 2005, 611 of a total of 619 such patients underwent the scan and form the study cohort. Coronal 3 mm T1 and Short Tau Inversion Recovery images were obtained using a 12 cm field of view as standard.

Results: There were 342 abnormal scans (56%) and 269 (44%) normal scans. Of the abnormal scans, 80% showed acute bony injuries, 8% showed acute soft tissue injuries and 12% showed incidental pathology.

Conclusions: MRI is a useful and effective tool in the diagnosis of radiologically occult wrist injuries. It is feasible to do MRI scans in a timely manner in a district general hospital.