Our Summary

This research paper looks into the overdiagnosis of scaphoid fractures, a type of wrist fracture, through the use of MRI scans. The researchers believe this overdiagnosis happens because the MRI scans sometimes show things that aren’t really fractures, which can lead to unnecessary treatment.

To confirm this, the researchers looked back at MRI scan images from patients who were thought to possibly have a scaphoid fracture. They found that only 6% of the images showed definite or probable fractures. However, 29% of the images had other changes that could be misinterpreted as fractures.

The researchers concluded that using routine MRI scans for suspected scaphoid fractures can lead to overdiagnosis and overtreatment. They suggest that MRI scans should be used more selectively, and that patients should be involved in decisions about their treatment.

FAQs

  1. What led the researchers to believe that scaphoid fractures are being overdiagnosed?
  2. What percentage of MRI scans showed definite or probable scaphoid fractures?
  3. What are the researchers’ suggestions to avoid overdiagnosis and overtreatment of scaphoid fractures?

Doctor’s Tip

In discussing scaphoid fracture surgery, a doctor may advise the patient to follow post-operative instructions carefully to ensure proper healing and successful recovery. This may include keeping the affected wrist immobilized, attending physical therapy sessions, and avoiding certain activities that could put stress on the healing bone. Additionally, the doctor may recommend regular follow-up appointments to monitor progress and make any necessary adjustments to the treatment plan. It is important for the patient to communicate any concerns or changes in symptoms to their doctor throughout the recovery process.

Suitable For

In cases where scaphoid fractures are confirmed, surgery may be recommended for patients who have displaced fractures, fractures that are not healing properly, or fractures that are at risk of non-union (where the bone fails to heal). Surgery may also be recommended for patients with certain types of scaphoid fractures, such as those that are located near the wrist joint or involve the blood supply to the bone.

Overall, the decision to recommend surgery for a scaphoid fracture will depend on the specific characteristics of the fracture, the patient’s age and activity level, and the goals of treatment. It is important for patients to discuss their treatment options with their healthcare provider and to weigh the potential risks and benefits of surgery before making a decision.

Timeline

Before scaphoid fracture surgery:

  1. Patient experiences a fall or injury to the wrist.
  2. Patient may have pain, swelling, and limited mobility in the wrist.
  3. Patient undergoes physical examination and possibly X-rays to diagnose the fracture.
  4. If the fracture is suspected but not clearly visible on X-rays, an MRI scan may be ordered.
  5. MRI scan may show possible fracture or other changes that could be misinterpreted as fractures.

After scaphoid fracture surgery:

  1. Patient undergoes surgery to repair the scaphoid fracture, which may involve internal fixation with screws or pins.
  2. Patient may need to wear a cast or splint to immobilize the wrist during the healing process.
  3. Patient undergoes physical therapy to regain strength and range of motion in the wrist.
  4. Follow-up appointments and imaging tests may be scheduled to monitor the healing progress.
  5. Patient gradually resumes normal activities and may experience improved function in the wrist over time.

What to Ask Your Doctor

  1. What are the risks and benefits of scaphoid fracture surgery?
  2. How long is the recovery process after surgery?
  3. Are there any alternative treatment options to surgery?
  4. What is the success rate of scaphoid fracture surgery?
  5. How much experience do you have performing scaphoid fracture surgeries?
  6. Will I need physical therapy after surgery?
  7. What can I expect in terms of pain management post-surgery?
  8. Are there any potential complications or long-term effects of scaphoid fracture surgery?
  9. How soon can I return to normal activities after surgery?
  10. Are there any lifestyle changes I should make to prevent future scaphoid fractures?

Reference

Authors: Bulstra AEJ, van Boxel MF, Crijns TJ, Kelly J, Obdeijn MC, Kerkhoffs GMMJ, Doornberg JN, Ring D, Jaarsma RL. Journal: Clin Orthop Relat Res. 2023 Dec 1;481(12):2309-2315. doi: 10.1097/CORR.0000000000002851. Epub 2023 Sep 14. PMID: 37707789