The role of magnetic resonance imaging in scaphoid fractures

Fractures of the scaphoid are the most common surgically treated carpal fracture, and early diagnosis is critical to minimize complications including osteonecrosis. If the initial radiographs after the injury are inconclusive, early magnetic resonance imaging (MRI) provides an immediate diagnosis to allow for proper management. This has been shown to be cost effective both in direct measureable costs and likely in difficult-to-measure indirect costs related to lost productivity. In the cases in which no scaphoid fracture is present, MRI provides alternate diagnoses such as identification of other fractures (eg, other carpals and distal radius), osseous contusions, and soft tissue injuries (preferably ≥ 1.5T). When MRI is contraindicated, computed tomography (CT) is a reasonable alternative after the initial and repeat negative radiographs. MRI is the best imaging modality for assessing osteonecrosis of the proximal pole in a scaphoid nonunion. Unfortunately, the most useful imaging sequences remain controversial. My institution relies on the noncontrast T1-weighted images for the primary diagnosis of osteonecrosis with dynamic contrast enhancement used in a supplemental fashion.