ACR Appropriateness Criteria® Acute Hand and Wrist Trauma

Abstract

Hand and wrist injuries are common reasons for musculoskeletal-related emergency department visits. Imaging is essential for evaluating many of these injuries. In most cases, conventional radiographs provide sufficient information to guide the treating clinician. This review focuses on seven common variants to guide diagnosis of hand and wrist injuries. In addition to radiographs, appropriate use of CT, MRI, bone scan, and ultrasound are discussed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Cost-effectiveness of introducing cone-beam computed tomography (CBCT) in the management of complex phalangeal fractures: economic simulation

“…As imaging modalities improve, reassessing diagnostic algorithms, considering imaging performance and testing cost, is mandatory to achieve costeffectiveness. Historically, this decision-making process has been dominated by concern for the negative sequelae of a non-union fracture [36,37] and, when initial radiographs are equivocal or in case of complex fractures (articular involvement or fragments angulation-dislocation), further multiplanar, high-resolution imaging with CT can be needed [16,17,20,21]. The choice between CBCT and MSCT may be justified by costs and performance characteristics: CBCT is a more cost-effective diagnostic modality due to high sensitivity and lower costs compared with MSCT [17][18][19]22].…”

“…Conversely, multi-slice computed tomography (MSCT) is not routinely performed in acute stage of injury [14,15]. It can, however, be useful in assessment of articular surface involvement for detection of small bone fragments and in case of joint subluxation [6,7,10,16]. Moreover, advanced imaging techniques are mandatory in case of equivocal findings depicted on initial radiographs [17][18][19].…”

“…In addition, malunion, delayed union, and non-union can be usually better assessed with MSCT [17][18][19][20]. Currently, MSCT is superior to CR in demonstrating intra-articular fracture lines and in the accuracy of fracture measurements (helpful in preoperative planning) because of slice thickness, isotropic, high-resolution multiplanar reconstruction (MPR) [16,17,21,22]. However, benefits of CT devices are associated with the problem of radiation burden [23].…”

Dose reduction potential in cone-beam CT imaging of upper extremity joints with a twin robotic x-ray system

“…While distal radius fractures are among the most frequent trauma consequences in any emergency department with particularly high incidence in elderly patients 1 – 3 , dislocations and fractures in the elbow region are more common in younger populations 4 . Plain radiographs usually represent the primary imaging method if traumatic injuries of the upper limb are suspected 5 . Radiograms offer a compromise between fast scan time, ubiquitous availability, and low radiation dose on the one side, and limited 2D image information on the other side 6 .…”

Twin robotic x-ray system in small bone and joint trauma: impact of cone-beam computed tomography on treatment decisions

“…Evaluation of extremity trauma is among the most common imaging tasks in any emergency department [1]. While digital radiography remains the primary means of fracture diagnosis due to cost-efficiency, low radiation dose, and ubiquitous availability, computed tomography (CT) can provide advantages over x-ray imaging in detection of subtle fractures or visualization of fracture displacement and assist pre-surgical planning [2][3][4]. Furthermore, cone-beam CT (CBCT) can contribute to trauma assessment by ruling out fractures that were suspected in previous radiography [5][6][7].…”