SNAITH, Beverly, HARRIS, Martine, HUGHES, James, SPENCER, Nicholas, SHINKINS, Bethany, TACHIBANA, Ayano, BESSANT, Gareth and ROBERTSHAW, Sarah (2022). Evaluating the potential for cone beam CT to improve the suspected scaphoid fracture pathway: InSPECTED: A single-centre feasibility study. Journal of medical imaging and radiation sciences, 53 (1), 35-40.
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Hughes-EvaluatingPotentialCone(VoR).pdf - Published Version
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Hughes-EvaluatingPotentialCone(VoR).pdf - Published Version
Available under License Creative Commons Attribution Non-commercial No Derivatives.
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Abstract
Background
The suspected scaphoid fracture remains a diagnostic conundrum with over-treatment a common risk-averse strategy. Cross-sectional imaging remains the gold standard with MRI recommended but CT used by some because of easier access or limited MRI availability. The aim of this feasibility study was to evaluate whether cone beam computed tomography (CBCT) could support early diagnosis, or exclusion, of scaphoid fractures.Methods
Patients with a suspected scaphoid were recruited fracture between March and July 2020. All underwent a 4-view X-ray. If this examination was normal, they were immediately referred for a CBCT scan of the wrist. Those with a normal scan were discharged to research follow-up at 2 and 6-weeks.Results
68 participants were recruited, 55 had a normal or equivocal X-ray and underwent CBCT. Nine additional radiocarpal fractures (16.2%) were demonstrated on CBCT, the remainder were discharged to research follow-up. Based on the 2-week and 6-week follow up three patients (4.4%) were referred for MRI to investigate persistent symptoms with no bony injuries identified.Conclusions
CBCT scans enabled a rapid pathway for the diagnosis or exclusion of scaphoid fractures, identifying other fractures and facilitating early treatment. The rapid pathway also enabled those with no bony injury to start rehabilitation, suggesting that patients can be safely discharged with safety-net advice following a CBCT scan.More Information
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