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An Algorithm for Acute Wrist Trauma

A systematic approach to diagnosis

From the Section for Hand Surgery, Department of Orthopaedic Surgery, Department of Diagnostic Radiology, Department of Medicine, and Department for Clinical Physiology and Nuclear Medicine, Odense University Hospital, Denmark

Correspondence: Claus Falck Larsen, M.D., Section for Hand Surgery, Department of Orthopaedic Surgery, Odense University Hospital, DK-5000 Odense, Denmark.

A systematic approach to the acute traumatized wrist is of importance to achieve early diagnosis, with efficient use of advanced imaging modalities. In a 6-month period 641 patients aged 15 years or over were examined using an algorithm for acute wrist trauma in order to secure early and appropriate treatment. In 293 (46%) cases routine radiographic examination supplied sufficient information to establish a fracture diagnosis. All 33 scaphoid fractures (including five scaphoid non-unions) were demonstrated on the initial X-ray examination. In 56 patients (9%) scintigraphy proved useful for selecting cases in need of further radiographic examination. Among 31 patients with focal activity on bone scintigraphy, CT and/or tomography revealed eight distal radial fractures, one fracture of the ulnar styloid, and eight fractures of carpal bones. Fractures were revealed using tomography and/or "hot spot views" in patients with negative CT examinations suggesting that further examinations should be performed in cases with increased focal activity on bone scintigraphy and a negative CT examination.

Journal of Hand Surgery (British and European Volume), Vol. 18, No. 2, 207-212 (1993)
DOI: 10.1016/0266-7681(93)90112-S


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