Scaphoid fractures are occult in up to 20% of normal radiographs and are important due to the risk of avascular necrosis and subsequent sequele that result in pain and reduced function1. Computed tomography, nuclear medicine and magnetic resonance imaging all have good sensitivity and specificity for detecting occult fractures2. In the UK, national guidelines advocate the consideration of magnetic resonance imaging as a first line diagnostic test for suspected scaphoid fractures1. The purpose of this study was to determine the spectrum of alternate diagnoses detected...

Retrospective review of all MRI scaphoids for trauma over a 12 month period. MRI sequences included coronal T1 and coronal STIR and were performed for persistent scaphoid clinical signs and normal plain radiographs. All fractures and soft tissue injuries were categorised into five zones as in figure 1. Data analysis was undertaken with microsoft excel.

One hundred thirty five MRI scaphoids were reviewed. There was 57 (42%) diagnosed fractures. Figure 2 illustrates the zonal distribution of fractures. Scaphoid fractures were diagnosed most frequently (39%) followed by fractures to the distal radius and ulna (28%). The ulna sided carpal bone group and metacarpals two through five group each contributed 12% of total fractures. An example of a zone 3 fracture is illustrated in figure 3. Nine percent of fractures were attributed to the trapezium and thumb metacarpal. There was 58 (43%)...

This study demonstrates that patients undergoing MRI scaphoid imaging for trauma can have fractures diagnosed in any region from distal forearm to proximal metacarpals. Somewhat surprisingly, investigation for query scaphoid trauma demonstrated injuries relatively distant to the suspected site of concern. For radiologists this study highlights that a thorough search for a multitude of bony and soft tissue injuries in all areas included in the study is important in order to avoid missing pathology. For colleagues managing patients directly it provides possible alternate diagnoses which...

1. National Institute for Health and Care Excellence. (2016) Fractures (non-complex): assessment and management (NICE guideline 38) 2016. Available at:https://www.nice.org.uk/guidance/ng38 [Accessed 27/04/2019] 2. Mallee WH, Wang J, Poolman RW et al. Computed tomography versus magnetic resonance imaging versus bone scintigraphy for clinically suspected scaphoid fractures in patients with negative plain radiographs. Cochrane Database of Systematic Reviews 2015, Issue 6. Art. No.: CD010023. DOI: 10.1002/14651858.CD010023.pub2

S Booth is a radiology trainee. L Walker is a radiographer. S Basu is a consultant MSK radiologist.