A new definition of wrist sprain necessary after findings in a prospective MRI study

Distal radial torus fracture in an adult. A new type of occult wrist fracture?

“…Dóczi et al 5 reviewed 626 wrist injuries diagnosed as wrist sprain, 39 of which were distal radial fractures discovered only after repeated examinations, so they suggested that to repeat standard four-view X-ray examination and other imaging methods (magnetic resonance imaging, MRI), are necessary to diagnose these occult fractures. Bergh et al 6 suggested that wrist sprain should be defined as occult partial or complete soft tissue (ligament, tendon, muscle) or bony injury in relation to a trauma with negative X-ray and stated that MRI should be considered as a part of an early diagnosis. Jorgsholm et al 7 only found a 43% sensitivity in the diagnosis of distal radius fractures with only plain radiographs compared with MRI.…”

“…These studies demonstrated that a considerable number of traumatic injuries originally diagnosed as wrist sprain were undiscovered distal radial fractures. According to Glickel et al 8 , and on the contrary to Bergh et al 6 , MRI is not reqired if the patient has a slight tenderness of the distal radial metaphysis and is immobilized properly, because the possibility to have an occult fracture is assumed. None of these authors makes any reference to an exceptional type of lesion in adults as the torus or buckle fracture, which is not easily diagnosed on plain X-ray, mainly in adult bone.…”

Review of MRI wrist examination since introduction of Medicare item number

“…It can lead to an occult fracture in a minority of cases (2%) . Many studies advocate bone bruising be treated with reduced length of immobilisation…”

Scaphoid Injury in Division III Collegiate Women’s Basketball Athlete

“…In conclusion, x-ray and MRI are key components in diagnosing and treating a wrist injury. 4 It is important to treat each case as unique, understand the deviations that can occur and be able to adapt accordingly.…”