Introducing CT scans into a clinical pathway to manage “clinical fractured scaphoid”

Implementing early CT scans to diagnose clinical fractured scaphoid and to avoid 10 days immobilization in plaster

Status

Recruiting

Phases

Phase 2

Study type

Interventional

Source

ANZCTR

Registry ID

ACTRN12606000219583

Enrollment

100

Registered

2006-06-01

Start date

2006-04-03

Completion date

Unknown

Last updated

2020-01-13

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

None listed

Brief summary

With a clinically suspected scaphoid fracture, initial x-rays are unreliable. Current local practice is immobilization in plaster for 10 days with repeat x-rays, in order to not miss fractures. In retrospect, up to 90% of patients do not need the plaster. Advanced imaging (early MRI and Day 4 Bone scans) are proven as an alternate best practice, but are expensive and difficult to access, and thus not often used. A research project at BHS has demonstrated that early CT scans are a reliable, accessible, cost effective alternative. Our aim is to confirm the use of early CT and to implement early CT scans into a “best practice” clinical pathway for suspected scaphoid fractures.

Interventions

Patients in the study will receive an early CT instead of the usual 10 days in plaster. Patients will be treated based on the results of the CT scan. If the CT shows a fracture, the patient would be treated for 6 weeks in plaster for a scaphoid fracture and 4 weeks in plaster for other carpal fractures. All patients with proven fractures will be reviewed by the orthopaedic registrar in the Fracture Clinic. Patients with no evidence of fracture on CT would be treated as a soft tissue injury and discharged home. These patients would be followed up via a phone call 10-14 days post injury. Those with ongoing pain or disability would be asked to present for review by the Emergency Consultant with in the next 48 hours for clinical examination and repeat CT or MRI if indicated.

Study design

Allocation

Non-randomised trial

Intervention model

Single group

Primary purpose

Diagnosis

Masking

Open (masking not used)

Eligibility

Sex/Gender

All

Age

14 Years to No maximum

Healthy volunteers

Inclusion criteria

A clinical scaphoid fracture will be defined as the presence of “snuffbox tenderness” in a patient with a mechanism of injury consistent with scaphoid trauma but normal initial radiographs. ED patients, who meet the clinical definition and had normal scaphoid x-rays.

Exclusion criteria

Patients who are known to be pregnantPatients who are unable to give informed consentPatients who do not consent to participate.

Outcome results