Scaphoid

Patients presents with wrist/hand Injury AND typical FOOSH or suspicious mechanism of injury

Clinical exam identifies clinical suspicion by identifying +ve signs (ALL must be documented)

• Anatomical snuffbox (ASB) tenderness

and/or

• Scaphoid tubercle tenderness

Patient discussed and reviewed by ENP (in ENP service hours) or >CT3/Consultant when there is no ENP service. Order scaphoid X-ray if agreed and write name of senior clinicain who reviewed the patient in the request (if not yourself)

1. ENP, >CT3/Consultant reviewing patient to request an 'URGENT' outpatient MRI scaphoid and include 'as per agreed scaphoid pathway ?fracture' in the details section
2. Futura wrist splint,
3. high arm sling,
4. Provide and read through the scaphoid Injury and MRI information with the patient.
5. Highlight safety netting.
6. Arrange follow up with scaphoid team via 'communicate' (see below)

1. Below elbow neutral POP backslab,
2. High arm sling,
3. Provide and read scaphoid injury and POP information leaflets with patient.
4. Highlight safety netting.
5. Arrange follow up with Scaphoid team  via 'communicate' (see below)

Any other associated Injuries? Carpal dislocation (perilunate) or median nerve symptoms

Discuss with plastics on call and treat as advised

Exceptions

• <12 y.o or >80 y.o. Not for MRI. Refer to NPC after negative x-ray
• Not suitable for MRI? Request urgent Wrist CT as an outpatient and arrange follow up with scaphoid team via 'comminicate'.
• Injury occured >4 weeks ago? Request urgent CT wrist as an outpatient and arrange follow up with scaphoid team via 'communicate'.

Scaphoid Senior Review

• All doctors below CT3 level should seek a senior review from an ENP when there is an ENP service (or >CT3/Consultant when there is not) for all suspected scaphoid fractures prior to requesting scaphoid x-rays.
• The senior clinician MUST physically assess the patient to ensure there are positive scaphoid signs.
• When ordering scaphoid x-rays, the name and grade of senior clinician must be stated in the request section.

Requesting an MRI (if injury>4weeks old, see requesting CT scan section below)

• MRI should only be requested on EPR by the senior clinician once x-rays reviewed together
• Ensure you request an MRI scaphoid and NOT an MRI Wrist
• Inform the patient that they will be contacted bt the Scaphoid team with details of theor appointment within 2 working days.
• Arrange follow up with scaphoid team via 'communicate'.

Requesting a CT scan (for patients whose injuries are > 4 weeks old or unable to have MRI)

• CT wrist should only be requested by CT3 and above clinicain once x-rays reviewed together
• Ensure you request CT wrist NOT CT scaphoid
• Inform the patient they will be contacted by CT or scaphoid team with details of their appointment within 2 working days.
• Arange follow up with scaphoid team via 'communicate'.

Arranging Follow up for ALL scaphoid patients

• All patients (whether they have a suspected or confirmed fracture) will be followed up by the scaphoid Fracture team
• Please refer via the 'communicate' button on EPR
  • To - Scaphoid Fracture Team
  • Confirm - Patient telephone number (verbally confirm, and document correct contact number in your documentation. Do not assume Number on EPR is correct)
  • Attach completed discharge summary