Reducing time from presentation to diagnosis of scaphoid fractures with cone beam CT: a before-and-after study
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By
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Leah Flanagan
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Sinead Loughran
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Bibi Ayesha Bassa
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Grainne Colgan
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Etimbuk Umana
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Vinny Ramiah
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Michael Mara
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July 1, 2026
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Clinical Scorecard: Improving Diagnosis Speed of Scaphoid Fractures Using Cone Beam CT: A Comparative Study Before and After Implementation
At a Glance
| Category | Detail |
|---|
| Condition | Scaphoid fractures |
| Key Mechanisms | Use of cone beam CT (CBCT) to improve diagnosis speed and accuracy. |
| Target Population | Patients with suspected scaphoid fractures presenting to the emergency department. |
| Care Setting | Emergency department and outpatient management. |
Key Highlights
- CBCT is an effective alternative to MRI for diagnosing scaphoid fractures.
- Implementation of a dedicated CBCT pathway increased the proportion of patients undergoing CBCT within 7 days.
- Early diagnosis with CBCT can reduce unnecessary immobilization and expedite patient care.
Guideline-Based Recommendations
Diagnosis
- Early MRI is recommended but limited by availability and cost.
- CBCT should be considered as an alternative to MRI in the investigation of suspected scaphoid fractures.
Management
- Timely diagnosis and management are crucial to prevent complications such as avascular necrosis and non-union.
Monitoring & Follow-up
- Regular follow-up imaging may be required for patients with negative initial plain film radiographs.
Risks
- Missed scaphoid fractures can lead to significant morbidity and complications.
Patient & Prescribing Data
Patients presenting with acute wrist injuries suspected of having scaphoid fractures.
Incorporating CBCT into the management pathway can improve diagnostic efficiency.
Clinical Best Practices
- Utilize CBCT for timely diagnosis of suspected scaphoid fractures.
- Implement standardized pathways for managing suspected scaphoid fractures in emergency settings.
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