Abstract
ObjectivesWe aimed to determine the prognosis after early MRI on clinical suspicion of scaphoid fracture, hypothesising that MRI pathology is associated with more disability and that MRI pathology and high occupational mechanical hand-arm exposures are associated with slower return to work (RTW).MethodsWe conducted a follow-up study of a cohort of 469 patients, who were scanned in the period 2006 to 2010. The respondents constituted our cohort for disability analysis and the subset that was in the labour market at the time of the trauma constituted our sub-cohort for RTW analysis. Questionnaires included disability scores, job title, and lifestyle factors. Job titles were linked with a job exposure matrix to estimate occupational exposures. Register information was obtained on time until RTW. We used logistic regression analysis of disability and Cox regression analysis of time until RTW.ResultsThe proportion that responded was 53% (249/469) for the disability analysis and 59% (125/212) for the RTW analysis. The mean age at follow up was 43.5 years, the mean time since trauma was 4.8 years, 53% had injury of the dominant hand, and 54% had MRI pathology. Men constituted 43% of the cohort and 56% of the sub-cohort. MRI pathology was not associated with more disability [e.g., for a 'Disabilities of the Arm Shoulder and Hand'-score ≥20 the odds ratio was 0.58 (95% confidence interval 0.26–1.17)]. Patients without MRI pathology and with low occupational exposures were off work for an average of four weeks. Patients with MRI pathology or high occupational exposures were off work for twice as long time.ConclusionMRI pathology was not associated with more disability. For patients, who were in the labour market at the time of the trauma, MRI pathology and high occupational mechanical hand-arm exposures were associated with slower RTW.
Highlights
Magnetic resonance imaging (MRI) is considered the golden standard in case of suspected scaphoid fracture [1,2,3,4], but the management of these patients varies [5]
magnetic resonance imaging (MRI) pathology was not associated with more disability
Who were in the labour market at the time of the trauma, MRI pathology and high occupational mechanical handarm exposures were associated with slower return to work (RTW)
Summary
Magnetic resonance imaging (MRI) is considered the golden standard in case of suspected scaphoid fracture [1,2,3,4], but the management of these patients varies [5]. MRI detects radiologically occult wrist injuries other than scaphoid fractures, including bone bruising and fractures of the distal radius, other carpal bones, and metacarpal bones. Most wrist injury patients achieve good functional outcomes, even in case of a displaced scaphoid fracture or non-union [6,7,8,9]. For wrist injury patients without MRI features of acute carpal pathology, the prognosis has not been described. The rate of RTW has not been studied in relation to quantitative measures of occupational mechanical hand-arm exposures (forceful work, repetitive work, and work with non-neutral postures)
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