Yıl 2019, Cilt 5, Sayı 1, Sayfalar 8 - 13 2019-01-04

A virtual pathway reduced the need for physical review in patients with a suspected scaphoid fracture

Paul J Jenkins [1] , Stephen Boyce [2] , Pauline Garvey [3] , Kevin Bee [4] , David Shields [5] , Lech A Rymaszewski [6]

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Objectives: Suspected scaphoid fractures are a common reason for referral from the emergency department to fracture clinics. Few patients actually have a fracture. Cross sectional imaging has the potential to improve early diagnosis and reduce unneccessary immobilisation. The aim of this audit was to investigate the effectiveness of a virtual pathway, incorporating early magnetic resonance imaging (MRI) scan, for suspected scaphoid fractures. The secondary aim was to investigate whether the accuracy of other clinical signs, such as anatomical snuffbox pain on wrist ulnar deviation, was sufficient to reduce the number of patients requiring a MRI scan.

Methods: A prospective audit was undertaken of 123 patients in an emergency department and associated minor injuries unit. These patients were managed with an early MRI scan. Where no significant injury was found, they were discharged after a phone call from a virtual fracture clinic nurse.

Results: There were 16 (13%) true scaphoid fractures. MRI scanning showed other injuries including significant soft tissue injuries (13%), other carpal fractures (17%) and fractures of the distal radius (19.5%). The number of clinical appointments required was 0.42 per patient. Eighty patients did not have any face-to-face review. Other clinical examination techniques, such as anatomical snuff box pain on ulnar deviation of the wrist were not sufficiently sensitive or specific to reduce the need for MRI scanning or review.

Conclusions: A virtual fracture clinic pathway and early MRI scanning reduced face-to-face reviews and unneccesary immobilisation. Clinical examination techniques are not sufficiently sensitive to reduce the need for scanning. 

Scaphoid, fracture, virtual fracture clinic
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Konular Sağlık Bilimleri ve Hizmetleri
Dergi Bölümü Original Article
Yazarlar

Orcid: 0000-0003-1175-0205
Yazar: Paul J Jenkins
Kurum: Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
Ülke: United Kingdom


Orcid: 0000-0003-3866-1851
Yazar: Stephen Boyce
Kurum: Department of Emergency Medicine, Glasgow Royal Infirmary, Glasgow, United Kingdom
Ülke: United Kingdom


Orcid: 0000-0002-7570-8965
Yazar: Pauline Garvey
Kurum: Department of Emergency Medicine, Glasgow Royal Infirmary, Glasgow, United Kingdom
Ülke: United Kingdom


Orcid: 0000-0002-0624-6955
Yazar: Kevin Bee
Kurum: Department of Dentistry & Nursing, University of Glasgow, School of Medicine, Glasgow, United Kingdom
Ülke: United Kingdom


Orcid: 0000-0003-4663-778X
Yazar: David Shields (Sorumlu Yazar)
Kurum: Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
Ülke: United Kingdom


Orcid: 0000-0003-3064-8337
Yazar: Lech A Rymaszewski
Kurum: Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
Ülke: United Kingdom


Bibtex @araştırma makalesi { eurj411396, journal = {The European Research Journal}, issn = {}, eissn = {2149-3189}, address = {Sağlık Araştırmaları ve Stratejileri Derneği}, year = {2019}, volume = {5}, pages = {8 - 13}, doi = {10.18621/eurj.411396}, title = {A virtual pathway reduced the need for physical review in patients with a suspected scaphoid fracture}, key = {cite}, author = {Jenkins, Paul J and Boyce, Stephen and Garvey, Pauline and Bee, Kevin and Shields, David and Rymaszewski, Lech A} }
APA Jenkins, P , Boyce, S , Garvey, P , Bee, K , Shields, D , Rymaszewski, L . (2019). A virtual pathway reduced the need for physical review in patients with a suspected scaphoid fracture. The European Research Journal, 5 (1), 8-13. DOI: 10.18621/eurj.411396
MLA Jenkins, P , Boyce, S , Garvey, P , Bee, K , Shields, D , Rymaszewski, L . "A virtual pathway reduced the need for physical review in patients with a suspected scaphoid fracture". The European Research Journal 5 (2019): 8-13 <http://dergipark.gov.tr/eurj/issue/40357/411396>
Chicago Jenkins, P , Boyce, S , Garvey, P , Bee, K , Shields, D , Rymaszewski, L . "A virtual pathway reduced the need for physical review in patients with a suspected scaphoid fracture". The European Research Journal 5 (2019): 8-13
RIS TY - JOUR T1 - A virtual pathway reduced the need for physical review in patients with a suspected scaphoid fracture AU - Paul J Jenkins , Stephen Boyce , Pauline Garvey , Kevin Bee , David Shields , Lech A Rymaszewski Y1 - 2019 PY - 2019 N1 - doi: 10.18621/eurj.411396 DO - 10.18621/eurj.411396 T2 - The European Research Journal JF - Journal JO - JOR SP - 8 EP - 13 VL - 5 IS - 1 SN - -2149-3189 M3 - doi: 10.18621/eurj.411396 UR - http://dx.doi.org/10.18621/eurj.411396 Y2 - 2018 ER -
EndNote %0 The European Research Journal A virtual pathway reduced the need for physical review in patients with a suspected scaphoid fracture %A Paul J Jenkins , Stephen Boyce , Pauline Garvey , Kevin Bee , David Shields , Lech A Rymaszewski %T A virtual pathway reduced the need for physical review in patients with a suspected scaphoid fracture %D 2019 %J The European Research Journal %P -2149-3189 %V 5 %N 1 %R doi: 10.18621/eurj.411396 %U 10.18621/eurj.411396
ISNAD Jenkins, Paul J , Boyce, Stephen , Garvey, Pauline , Bee, Kevin , Shields, David , Rymaszewski, Lech A . "A virtual pathway reduced the need for physical review in patients with a suspected scaphoid fracture". The European Research Journal 5 / 1 (Ocak 2019): 8-13. http://dx.doi.org/10.18621/eurj.411396