Wrist fractures: sensitivity of radiography, prevalence, and patterns in MDCT

Abstract

The aims of this study are to evaluate diagnostic performance of conventional radiographs for wrist fractures using multidetector computerized tomography (MDCT) as a reference standard, to determine prevalence, demographic risk factors including age and sex, and associations among various wrist fractures. A retrospective study was performed, finding a total 455 patients (457 wrists) who had wrist trauma and who had undergone a radiography and subsequent MDCT examination during a 45-month period. The MDCT and radiographs of the patients were reviewed by two radiologists, and a consensus was obtained for the presence of fracture. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of radiographs were calculated using MDCT findings as reference standard. The correlation of both age and sex between the presence of fracture was also analyzed. Of the 455 patients, 223 (49.0 %) had one or more fractures in wrist. A total of 302 (160 patients had one, 50 had two, 10 had three, and 3 had four) fractures were diagnosed in the wrist region. In 457 wrists, MDCT revealed 128 occult fractures missed by radiography. The overall sensitivity, specificity, PPV, and NPV of radiography for the detection of all wrist fractures were 57.8, 99.5, 87.4, and 97.4 %, respectively. The sensitivities of radiography ranged 0-41.2 % for other carpal bone except scaphoid (66 %) fractures and 66.7-80 % for the proximal metacarpus, distal ulna, and radius fractures. Wrist fractures appear to be overlooked on radiography. Further imaging should be warranted for patients who are clinically suspicious for wrist fracture in emergency rooms.

The utility of cross‐sectional imaging in the management of suspected scaphoid fractures

“…The American College of Radiologists recommended MRI as the best second‐line investigation, however, since then the number of MRIs performed in scaphoid fracture diagnosis has not significantly increased despite MRI changing the management of clinically suspected scaphoid fracture cases in 92% of cases . Additionally, it is reported that in approximately 10% of cases scaphoid fractures are concomitant with other fractures of the hand or wrist, fractures which are often radiographically occult, such as capitate and lunate fractures . Frequently, the signs and symptoms of clinically suspected scaphoid fractures are due to other bony or soft tissue injuries, as in 50.0% of our cohort.…”

Emergency physicians performed Point-of-Care-Ultrasonography for detecting distal forearm fracture

“…Balci et al, examined diagnostic performance of conventional radiographs for wrist fractures using multidetector CT as a reference standard 1 . They revealed that sensitivity of x-ray for radius fracture is only 72.8% and 80% for ulna fracture.…”

“…There is a lack of evidence for the utility of sonographic (US) examination for detecting of distal forearm fracture in adults. Standard imaging tool for the diagnosis of distal forearm fracture is X-ray, however it's sensitivity is low 1, 2…”

Review of supplemental views and stress radiography in musculoskeletal trauma: upper extremity

“…Wrist fractures may be occult on the standard dorsoplantar, oblique, and lateral wrist radiographs warranting further imaging for patients with persistent clinical suspicion for a fracture [10].…”