Management of clinically suspected scaphoid fractures: a survey of current practice in Israel.

BACKGROUND Fracture of the scaphoid is the most common fracture of a carpal bone. Nevertheless, the diagnosis of SF might be challenging. Plain X-rays that fail to demonstrate a fracture line while clinical findings suggest the existence of such a fracture is not uncommon. Currently there is no consensus in the literature as to how a clinically suspected SF should be diagnosed, immobilized and treated. OBJECTIVES To assess the current status of diagnosis and treatment of clinically suspected scaphoid fractures in Israeli emergency departments. METHODS We conducted a telephonic survey among orthopedic surgeons working in Israeli EDs as to their approach to the diagnosis and treatment of occult SF. RESULTS A total of 42 orthopedic surgeons in 6 hospital EDs participated in the survey. They reported performing a mean of 2.45 +/- 0.85 clinical tests, with tenderness over the snuffbox area being the sign most commonly used. A mean of 4.38 +/- 0.76 X-ray views were ordered for patients with a clinically suspected SF. The most common combination included posterior-anterior, lateral, semipronated and semisupinated oblique views. All participating surgeons reported immobilizing the wrists of patients with occult fractures in a thumb spica cast based on their clinical findings. Upon discharge from the ED patients were advised to have another diagnostic examination as follows: 29 (69%) repeated X-rays series, 18 (43%) were referred to bone scintigraphy and 2 (5%) to computed tomography; none were referred to magnetic resonance imaging. CONCLUSIONS No consensus was found among Israeli orthopedic surgeons working in EDs regarding the right algorithm for assessment of clinically suspected SF. There is a need for better guidelines to uniformly dictate the order and set of tests to be used in the assessment of occult fractures.