Cost analysis of traditional follow-up protocol versus MRI for radiographically occult scaphoid fractures: a pilot study for the Accident Compensation Corporation.

AIMS: Assessment of the cost-effectiveness of early magnetic resonance imaging (MRI) for suspected radiographically occult scaphoid fractures. Methods Compare costs of patients presenting acutely with suspected scaphoid injuries (managed either with traditional follow-up radiographs and plasters) versus early MRI to exclude a fracture. Results The average medical cost for the control group was NZ470 dollars versus NZ533 dollars in the MRI group. The cost to exclude a fracture was NZ437 dollars with MRI versus NZ459 dollars for the traditional protocol. Weekly compensation costs were comparable. Conclusions The early diagnosis of clinical scaphoid fractures has clear clinical advantages. The use of MRI in this situation is cost-effective, and we recommend that it be offered as part of the routine investigative work-up available for this difficult, but common, clinical scenario.