Systematic Checklist Approach to the Radiographic Interpretation of the Injured Wrist to Avoid Common Diagnostic Errors

Abstract

Radiography is the fi rst-line imaging modality for the evaluation of traumatic wrist injury, which is encountered commonly in the daily practice of a diagnostic radiologist. Because of the complex anatomy and overlapping structures of the wrist on standard radiographic projections, abnormalities of the wrist can be subtle and easily overlooked. Therefore, it is essential for radiologists to be profi cient at the interpretation of wrist radiographs. The use of a checklist approach, and recognition of common injury patterns, potentially can increase radiologists' accuracy when interpreting standard wrist radiographs. The objective of this article is to present a simple but thorough method for accurate radiographic evaluation of the wrist and to review some common injury patterns of the wrist. Radiographic Evaluation of the WristCommon views of the wrist include posteroanterior (PA), lateral, and oblique projections. With the PA view, the wrist V o l u m e 3 8 • N u m b e r 2 0 S e p t e m b e r 3 0 , 2 0 1 5 This issue of CDR will qualify for 2 ABR Self-Assessment Module SAM (SA-CME) credits. See page 8 for more information. This module meets the American Board of Radiology's (ABR's) criteria for self-assessment toward the purpose of fulfi lling requirements in the ABR Maintenance of Certifi cation (MOC) program.Please note that in addition to the SA-CME credits, subscribers completing the activity will receive the usual ACCME credits. After participating in this activity, the diagnostic radiologist should be better able to identify the anatomic landmarks of the wrist on radiography and become familiar with a systematic checklist approach to the radiographic interpretation of the injured wrist.

Prevalencia de lesiones traumáticas ocultas en muñeca y tobillo: revisión sistemática y metaanálisis

“…Este estudio mostró una prevalencia global alta de fracturas ocultas de muñeca (36%) y tobillo (34%), explicado por la anatomía compleja de la muñeca y tobillo, superposición de estructuras óseas y presencia de variantes anatómicas, que dificultan la valoración con la radiografía convencional 5,[14][15][16] .…”

“…En cuanto a lesiones de tejidos blandos ocultas en tobillo identificadas por RM (1 estudio incluido), la prevalencia fue del 98,8%; esto puede explicarse debido a que la radiografía no es un método diseñado para la detección de lesiones de tejidos blandos como lo es RM 13,18 . Minor et al 14 proponen que una radiografía de muñeca debe ser evaluada de acuerdo con las proyecciones. En la proyección anteroposterior se debe evaluar (Fig.…”

Prevalence of missed wrist and ankle traumatic injuries: systematic review and meta-analysis

“…This study showed a high global prevalence of occult fractures of the wrist (36%) and ankle (34%), explained by the complex anatomy of the wrist and ankle, overlapping bone structures, and the presence of anatomical variants, which make evaluation difficult with the conventional radiography 5,[14][15][16] .…”

“…Minor and Bui-Mansfield 14 propose that a wrist X-ray should be evaluated according to the projections. In the anteroposterior projection, the following should be evaluated (Fig.…”