Scaphoid fractures: has magnetic resonance imaging become a cost-effective alternative to definitive diagnosis?
BACKGROUND
A clinical examination finding of anatomical snuffbox tenderness (AST) with plain film radiographs alone yields low sensitivity and specificity in diagnosing scaphoid fractures. International guidelines suggest immediate referral for magnetic resonance imaging (MRI) following one non-diagnostic radiograph in such patients. Perceived cost, high demand and limited capacity of MRI scanners have resulted in few suspected fractures following this pathway in our institution.


AIMS
Our study aimed to audit cost-effectiveness of immediate MRI referral following one non-diagnostic radiograph in the patient with AST versus current local practice.


METHODS
Retrospective analysis of all patients with suspected scaphoid fractures referred from the ED to the orthopaedic service over a six-month period was performed. Mean pricing per radiograph, casting, MRI and fracture clinic presentation was obtained from our hospital's Finance department.


RESULTS
Ninety-seven patients were identified; 26 had scaphoid fractures (26.8%). Seventy-one patients with no fractures cost a mean €82,111.50 (IQR: €55,025, €98,335) having a mean of 3.1 clinic visits, 4.6 radiographs and 4.7 weeks casted, versus €40,115 for early MRI referral as per guidelines (p > 0.05).


CONCLUSIONS
In conclusion, when compared with current local practice, immediate referral of the patient with AST for MRI following one non-diagnostic ED radiograph is potentially cost-effective in establishing efficient diagnosis of scaphoid fractures. We recommend the implementation of published international guidelines in the investigation of query scaphoid fractures as a pragmatic and cost-effective practice.
['Davey|Martin|M|http://orcid.org/0000-0002-3229-6032', 'Feeley|Ian|I|', 'Hayes|Joshua|J|', 'Grant-Freemantle|Marc|M|', 'Gaafar|Muhammad|M|', 'Pauzenberger|Leo|L|', 'Byrne|Ann Maria|AM|', 'Mullett|Hannan|H|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D003362:Cost-Benefit Analysis D005260:Female D050723:Fractures, Bone D006801:Humans D008297:Male D008875:Middle Aged D012189:Retrospective Studies D021361:Scaphoid Bone D055815:Young Adult
Scaphoid Fracture Diagnosis MRI Cost