Testing an alternative X-ray technique to detect wrist fractures.
Research type
Research Study
Full title
The detection of occult scaphoid fractures - a pilot study comparing planar digital tomosynthesis to gold standard MRI imaging.
IRAS ID
135067
Contact name
Emma-Louise Gerety
Contact email
Sponsor organisation
Cambridge University Hospitals NHS Foundation Trust
Research summary
It is essential that scaphoid (small bone of the wrist) fractures are not missed, as this can lead to permanent disability and potential litigation. Undisplaced scaphoid fractures may not be seen on plain radiographs (X-rays), despite clinical signs of a scaphoid fracture - termed an ’occult’ fracture. Patients often have their wrist immobilized in a plaster cast for several weeks despite negative radiographs, in case there is an occult fracture. This could be avoided by diagnosis with Magnetic Resonance Imaging (MRI), however resources do not allow for all patients with suspected scaphoid fractures to have MRI. Digital tomosynthesis is an alternative X-ray technique which is relatively cheap and available. If digital tomosyntheis detects/ rules out scaphoid fractures accurately, many patients could avoid unnecessary immobilisation and the associated loss of productivity at work and other activities, reducing loss of income to the patient and the community. This would also avoid potential further imaging which is expensive for the NHS and may involve a further radiation dose for the patient.
Following the results of an audit of scaphoid fracture imaging, we would like to perform a pilot research study comparing the detection of scaphoid fractures by plain radiograph scaphoid series, digital tomosynthesis and MRI. MRI is generally considered to be the gold standard for detection of scaphoid fractures. We propose to recruit 24 patients aged 18-40yrs from the Fracture Clinic, who have pain in the wrist suggesting a scaphoid fracture despite normal radiographs. After appropriate patient information and consent, these patients would be imaged with a scaphoid series of radiographs, digital tomosynthesis and MRI on the same day. The results would be independently reported and compared for statistical significance.
We aim to determine whether digital tomosynthesis is worse, the same or better than radiographs and MRI for detection of scaphoid fractures.REC name
East of England - Cambridge East Research Ethics Committee
REC reference
14/EE/0079
Date of REC Opinion
27 Mar 2014
REC opinion
Favourable Opinion