שנה שפה:

Advanced Imaging for Suspected Scaphoid Fractures using the MRI Wrist 2 System



Erez Avisar, Ger A. Persitz, Y Keren T, B. Friedman, Gabriel Agar
Hand & Upper Extremity Surgery Unit Assaf Harofeh Medical Center Zrifin Orthopedic Division Asaf Harofeh Medical Center, Hebrew University School of Medicine, Israel

Negative radiographs in the setting of suspected scaphoid fractures is well known but unsolved clinical dilemma. MRI is a well-known and established diagnostic modality with high sensitivity and specificity for scaphoid fracture diagnosis. The main problem using MRI for early diagnosis of occult scaphoid fracture is the availability and cost. Wrist 2 MRI system is a novel office based 1T MRI scan. The purpose of this study was to evaluate the clinical application of MRI WRIST 2 System for early evaluation of suspected scaphoid wrist fractures.

Results: Thirty Patients diagnosed as occult scaphoid fracture were enrolled in the study. Twenty-five patients underwent MRI WRIST 2 scan 2-4 days after presentation to the ER. All scans were immediately revised by hand surgeon and confirmed by musculoskeletal radiologist. Five patients were enrolled to the traditional occult scaphoid fracture flowchart which includes.

Eight Out of 25 WRIST 2 MRI demonstrated acute scaphoid fracture line and one case demonstrate non displaced capitate fracture and one case demonstrate hamate body fracture. Positive scaphoid fracture scans for demonstrate associated wrist injury In 14 normal MRI scan, plaster was removed after WRIST 2 MRI scan and patients returned to normal activity. Three cases of Gr-2 bone edema without overt wrist fracture line treated by 4 weeks splint. Thirty days follow up all patients were pain free with full wrist range of motion. Five patients were enrolled to the standard occult scaphoid fracture protocol. The average time to plaster removal was 4 weeks, in patient whom scaphoid fracture was ruled out.

Conclusions: Early MRI wrist 2-system scan (2-4 days after injury) for suspected scaphoid fractures gain high availability, it reduce an unnecessary immobilization time compared to the conventional occult scaphoid fracture management. It also enables early detection and appropriate treatment of scaphoid and associated occult wrist injuries.

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Erez Avisar