Use of early magnetic resonance imaging in the diagnosis of occult scaphoid fractures: The CAST Study (Canberra Area Scaphoid Trial)

Aim: To establish the effectiveness of early magnetic resonance imaging (MRI) in the diagnosis of scaphoid fracture in patients with suggestive clinical findings (but a normal initial X-ray) in an Australian major-referral emergency department Methods: A prospective study of patients who presented within 24 hours after trauma with clinical findings suggestive of a scaphoid fracture but no evidence of fracture on the initial X-ray. MRI was performed within 24 hours of presentation. Clinical review in patients with normal initial MRI was carried out in 10 days and repeat MRI was carried out when clinically indicated. Results: A total of 22 patients were enrolled. Early MRI within 24 hours revealed 6 scaphoid fractures, 2 distal radial fractures and a hamate fracture. Thirteen patients had no fracture on the initial MRI. Upon clinical review in 10 days, 5 of these patients were clinically cleared and discharged. Eight of these patients underwent repeat MRI none of which revealed a fracture. Conclusions: In an Australian tertiary hospital with MRI facility, the early use of MRI is a sensitive and practical way to diagnose occult scaphoid fractures and saves unnecessary immobilisation.