Outcome of wrist injuries with clinical suspicion of scaphoid injury after normal computed tomography.

OBJECTIVES

Wrist injuries are a common presentation to emergency departments. A clinical pathway has recently been introduced in our institution for patients with clinical suspicion of a scaphoid injury, using computed tomography (CT) at 2 weeks postinjury to rule out scaphoid fracture. However, it is not known what happens to patients who have a normal CT after such an injury. The aim of this pilot study was to assess disability after CT-negative wrist injuries.

METHODS

A prospective questionnaire study was undertaken to assess disability in patients who had a normal CT after clinical suspicion of a scaphoid fracture, using the Patient Rated Wrist Evaluation questionnaire. Adult patients were recruited at their first emergency department clinic review, where a baseline questionnaire was completed. Follow-up questionnaires were sent 3, 6 and 12 months later. Pain and function were assessed on a 0-10 scale, giving a total score out of 100.

RESULTS

Ninety-nine patients were initially recruited, of whom 72 had negative CT; 40 patients completed follow-up. There was a statistically significant reduction in pain, functional deficit and combined disability between baseline scores and 12-month follow-up. Overall, three (8%) patients had severe disability (pain and function combined), and six (15%) had moderate disability at 12 months.

CONCLUSION

The majority of these patients recover from their injury, but a small proportion with normal CT scans have considerable disability 12 months after injury. Appropriate advice should be given to these patients to enable them to access further investigation and treatment.