1. The utilisation of MRI in the assessment of suspected scaphoid fracture
Background
Hand injury is a common presentation at A&E in the UK
Only 60% of scaphoid fractures are picked up by conventional imaging i.e. X-ray.
40% of the patients with missed fracture present later on with complications/delayed union of bone making it costlier to provide corrective treatment
The clinical challenge:
Clinical and radiographic diagnosis of scaphoid fractures is often challenging, particularly at time of presentation
Various clinical complications may arise from a misdiagnosed scaphoid fracture, potentially leading to poor clinical outcomes
STUDY AIM: The TOHETI study will assess the use of MRI as an additional imaging technique to X-ray scans, where no definitive diagnosis is obtained from an initial X-ray alone, in order to allow earlier, definitive diagnosis.
Study details
The study will take place at A&E (St Thomas’) and UCC (Guy’s Hospital).
Recruitment will take place over 17 months, starting from June 2016
The study aims to recruit 136 patients in total
All patients with suspected scaphoid fracture that enter A&E/UCC will undergo x-ray as the initial imaging test to assess their potential injury.
Following that, patients with:
findings suggestive of scaphoid fracture will receive immediate treatment and will not be included in the study
patients with no findings suggestive of scaphoid fracture, will be invited to take part in the study.
Outcomes
Expected impact
Patient experience and satisfaction
Improved patient experience and satisfaction
Improves the diagnostic pathway by providing an early and accurate diagnosis and, subsequently, appropriate and timely treatment
Quality of care
Better patient outcomes by avoiding initial misdiagnosis of scaphoid fractures.
Cost effectiveness
Improved patient outcomes at a similar or reduced cost per patient, particularly from a societal perspective
Cost of additional MRI scan predicted to be offset by savings made in decreasing the amount of unnecessary diagnostic and treatment procedures
“This is a great opportunity to change the discourse around the most effective and accurate way of imaging patients with suspected scaphoid fractures, when they first attend A&E, and thereby significantly improve the quality of patient care” 
Sam Gidwani, Consultant Orthopaedic Hand Surgeon, Chief Investigator TOHETI Scaphoid Research Pathway
CONTACT US: Project Manager: Ms Bharti Malhotra Ext