[Cast immobilisation for suspected scaphoid fractures].

Background: Patients with suspected scaphoid fractures usually have their arm immobilised in a cast for two weeks, even in the absence of radiographic signs of fracture. After two weeks a new radiographic examination is performed. Our objective was to assess the extent of unnecessary cast immobilisation and to describe existing diagnostic practice in our hospital.

Material And Methods: We performed a retrospective study to identify all patients treated for suspected scaphoid fracture in our hospital in the period 2001 - 2006. The extent of unnecessary immobilisation and the use of diagnostic procedures were assessed by systematic review of patients' medical records.

Results: 45 of 194 patients treated as if they had a scaphoid fracture were diagnosed with a fracture; 29 by plain radiographs at the first consultation and 16 at later consultations (nine by plain radiographs after two weeks, three by MRI after two weeks and four by repeated clinical assessments for maximum 10 weeks). 89 patients of working age and without scaphoid fracture were treated with cast immobilisation for 187 weeks in total.

Interpretation: Only 23 % of patients treated with cast immobilisation for two weeks were ultimately diagnosed with scaphoid fracture. The extent of unnecessary cast immobilisation indicates a need to use better diagnostic tools early after the injury.