Cost-Effectiveness of Immediate MR Imaging Versus Traditional Follow-Up for Revealing Radiographically Occult Scaphoid Fractures

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Abstract
OBJECTIVE. For suspected scaphoid fractures with no radiographic evidence of fracture, treating symptoms with immobilization and radiographic follow-up has long been the standard of care. Modified MR imaging of the wrist is offered at our institution in screening for radiographically occult scaphoid fractures at the time of initial presentation to the emergency department. We show the advantages and comparative costs of this modified protocol versus a traditional protocol.MATERIALS AND METHODS. Our modified protocol consists of coronal thin-section T1-weighted and fast spin-echo T2-weighted MR images with fat saturation. A review of the literature was performed to assess the accuracy of clinical examination, radiography, and other modalities in the evaluation of scaphoid fractures of the wrist. Charges for this procedure are compared with charges for traditional follow-up.RESULTS. Three of four patients with positive results at clinical examination and negative findings on initial radiographs will be need...

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