In our place it's a Futuro splint followed by A&E review in 4-5 days. Urgent
MRI if still clinically suspicious (no point in re-peating X-Ray at that
early stage). MRI must be requested by Middle Grade or above to prevent the
inevitable abuse of an SHO operated system.
We used to go for Bone Scan. When we researched MRI it became apparent that
you have about 4 weeks freedom whereby lack of POP immobilisation does not
increase risk of complications so we aim to get an injury-to-diagnosis time
within that period and usually manage 2-3 weeks. We audit that and delays
are usually due to delayed presentation and people then not recognising the
need to hurry the normal process along.
Before anyone shouts, I know it's not core A&E work - I had an interest in
it and it evolved that way in our hospital - it needs agreement between
Specialties and there is the flow of funding to be considered if starting
afresh.
Nick Jenkins
A&E Consultant, Abergavenny
http://www.ae-nevillhall.org.uk
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]]On Behalf Of Tudor Codreanu
Sent: 20 June 2004 15:39
To: [log in to unmask]
Subject: is it a scaphoid fracture?
Due to a legal pressure on our department, we are now asked to provide a
written protocol regarding the "clinically" fractured scaphoid.
I would be grateful for your examples of way of thinking, especially for
the fell-on-outstreched-hand-pain-in-the-snuff-box-normal-Xray-at-
presentation kind of patients. Also, what is your review time, in what a
review consists and for how long you review them?
More than happy to receive comments off the list!
Best wishes,
Dr Tudor Codreanu
A&E Elgin
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