In a recently published study, researchers from King’s College London and Guy’s & St Thomas’ NHS Foundation Trust evaluated the clinical and cost implications of using immediate MRI in the management of patients with a suspected fracture of the scaphoid. They found that the immediate use of an MRI on patients who present with a possible scaphoid fracture allowed for a quicker and more accurate diagnosis with higher levels of patient satisfaction. 

The scaphoid is one of eight small bones that make up the wrist and connects the rows of bones together with the forearm bone. The scaphoid is often fractured due to a fall on an outstretched hand.

At present, the management of a suspected scaphoid fracture is challenging. Possible fractures can be diagnosed by an x-ray however they may not always be seen on the x-ray and can leave the patient with persistent pain, the potential for further problems and reduced quality of life.

Lead author, Tiago Rua, commented 'we found that compared with the current standard of care, the use of immediate MRI in the management of suspected scaphoid fractures was cost-neutral at three months and demonstrated cost savings at six months post-injury'. 

The study’s SMaRT (Scaphoid Magnetic Resonance Imaging in Trauma) trial considered the innovative use of MRI in the management of suspected scaphoid fractures on presentation to the Emergency Department. The use of an expensive but more accurate technology streamlined subsequent care, enabling a quicker diagnosis, whilst reducing overall costs to the NHS and promoting value-based healthcare.

Based on this evidence, the use of immediate MRI as an add-on test is currently being operationalised to be included as part of the standard of care at Guy’s and St Thomas’ NHS Foundation Trust.