RecruitingPhase 2ACTRN12606000219583

Introducing CT scans into a clinical pathway to manage “clinical fractured scaphoid”

Implementing early CT scans to diagnose clinical fractured scaphoid and to avoid 10 days immobilization in plaster

Sponsor

Ballarat Health Services (BHS)

Enrollment

100 participants

Start Date

Apr 3, 2006

Study Type

Interventional

Conditions

Clinical Scaphoid fracture. Ie, 'anatomical snuffbox' tenderness with normal plain x-rays

Summary

With a clinically suspected scaphoid fracture, initial x-rays are unreliable. Current local practice is immobilization in plaster for 10 days with repeat x-rays, in order to not miss fractures. In retrospect, up to 90% of patients do not need the plaster. Advanced imaging (early MRI and Day 4 Bone scans) are proven as an alternate best practice, but are expensive and difficult to access, and thus not often used. A research project at BHS has demonstrated that early CT scans are a reliable, accessible, cost effective alternative. Our aim is to confirm the use of early CT and to implement early CT scans into a “best practice” clinical pathway for suspected scaphoid fractures.

Eligibility

Sex: Both males and femalesMin Age: 14 Yearss

Plain Language Summary

Simplified for easier understanding

This study is testing whether an early CT scan can reliably diagnose a suspected broken scaphoid bone in the wrist — instead of the standard approach of putting the wrist in plaster for 10 days and repeating X-rays. Many people with wrist pain after a fall are placed in plaster even though up to 90% don't actually have a fracture. An early CT scan may quickly confirm whether a fracture exists and avoid unnecessary treatment. You may be eligible if: - You are 14 years of age or older - You came to the emergency department with wrist pain after an injury - Your initial X-rays are normal but you have tenderness in the "snuffbox" area (a dimple at the base of the thumb) - You are able to give informed consent You may NOT be eligible if: - You are known to be pregnant - You are unable to give informed consent - You do not wish to take part Talk to your doctor about whether this trial might be right for you.

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Interventions

Patients in the study will receive an early CT instead of the usual 10 days in plaster. Patients will be treated based on the results of the CT scan. If the CT shows a fracture, the patient would be

Patients in the study will receive an early CT instead of the usual 10 days in plaster. Patients will be treated based on the results of the CT scan. If the CT shows a fracture, the patient would be treated for 6 weeks in plaster for a scaphoid fracture and 4 weeks in plaster for other carpal fractures. All patients with proven fractures will be reviewed by the orthopaedic registrar in the Fracture Clinic. Patients with no evidence of fracture on CT would be treated as a soft tissue injury and discharged home. These patients would be followed up via a phone call 10-14 days post injury. Those with ongoing pain or disability would be asked to present for review by the Emergency Consultant with in the next 48 hours for clinical examination and repeat CT or MRI if indicated.

Locations(1)

Australia

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ACTRN12606000219583