In a cost-effectiveness study, we compared a treatment algorithm using repeated radiological examination with an algorithm using subacute MRI in patients with clinical signs of scaphoid fracture but normal initial radiography. Twenty-seven patients were included in both groups, and MRI reduced the immobilisation time from 20 days (range, 6–54) to 4 days (range, 1–19) and sick leave from 27 days (1–92) to 11 days (0–28). Use of MRI increased hospital costs by €151 ( P<0.05), but reduced non-hospital costs by €2869 ( P<0.05), making MRI cost-effective in the treatment of suspected scaphoid fractures.