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    Rizki Putri Andini
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    Radiography failed to detect 30% of wrist fractures identified on CT scans. Certain fracture patterns, like dorsal scaphoid avulsion fractures, require specific radiographic views or CT to detect. Lunate, triquetrum, trapezoid, capitate and hamate fractures were often missed on initial radiographs. CT is important for detecting fractures missed on initial radiographic examination of the wrist.

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    Jurding radiologi

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    Radiography failed to detect 30% of wrist fractures identified on CT scans. Certain fracture patterns, like dorsal scaphoid avulsion fractures, require specific radiographic views or CT to detect. Lunate, triquetrum, trapezoid, capitate and hamate fractures were often missed on initial radiographs. CT is important for detecting fractures missed on initial radiographic examination of the wrist.

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    28 views22 pages

    Journal Reading Radiologi

    Uploaded by

    Rizki Putri Andini
    Radiography failed to detect 30% of wrist fractures identified on CT scans. Certain fracture patterns, like dorsal scaphoid avulsion fractures, require specific radiographic views or CT to detect. Lunate, triquetrum, trapezoid, capitate and hamate fractures were often missed on initial radiographs. CT is important for detecting fractures missed on initial radiographic examination of the wrist.

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    © All Rights Reserved
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    of 22

    Journal Reading

    MDCT and Radiography of Wrist Fractures:


    Radiographic Sensitivity and Fracture Patterns

    Pembimbing : dr. Novita E.R, SpRad

    Rizki Putri Andini R


    1710221017

    KEPANITERAAN KLINIK DEPARTEMEN RADIOLOGI


    PERIODE 12 MARET – 14 APRIL 2018
    RUMAH SAKIT UMUM DAERAH AMBARAWA, UNGARAN
    KAB. SEMARANG, JAWA TENGAH
    Introduction
    Trauma to the wrist can cause significant soft-tissue and osseous injury, with
    scaphoid fractures accounting for up to 70% of carpal bone fractures

    Because of the difficulty in recognizing wrist fractures in acute injuries, many


    fractures are not found at initial radiographic examination

    Radiographic examination is routinely used in the initial evaluation of a suspected


    acute wrist fracture. However, because of overlapping structures, possible
    suboptimal positioning and technique, lack of dedicated special radiographic
    views, and other problems inherent to radiographic analysis, missed wrist
    fractures do occur

    Because of this, other imaging methods such as CT are also used both in the
    primary evaluation of suspected wrist fractures and in the assessment of bone
    healing after fracture
    Objective Article

    The purpose of our study was to determine which wrist


    fractures are not prospectively diagnosed at radiography
    using CT as a gold standard and to identify specific fracture
    patterns.
    Material and Methods
    Through a search of radiology records from January 1 to December 31,
    2005, 103 consecutive patients were identified as having radiographic
    and CT examinations of the wrist. After excluding incomplete or
    nondiagnostic examinations and those with a greater than 6-week
    interval between imaging studies, the final study group consisted of 61
    wrist examinations in 60 patients. Two musculoskeletal radiologists
    and one emergency radiologist blindly reviewed CT examinations, and
    each bone (scaphoid, lunate, triquetrum, pisiform, trapezium,
    trapezoid, capitate, hamate, metacarpals, distal radius, distal ulna) was
    categorized as normal or fractured, with agreement reached by
    consensus. Each prospective radiographic report was categorized as
    either normal or fracture/equivocal for each osseous structure. Results
    were compared using the chi-square and Fisher’s exact tests.
    Results
    • A total of 61 wrists were evaluated in our study. The study population included 27
    men and 33 women. Patient ages ranged from 10–80 years (mean age, 37 years).
    Thirty-three of 61 (54%) cases were of the right wrist compared with 28 of 61
    (46%) of the left. Mechanisms of injury included fall, motor vehicle accident,
    athletic injury
    • CT showed a total of 69 fractures in 45 of 61 (74%) wrists. Of these cases with
    fracture at CT, radiography reports indicated a total of 48 fractures in 39 of 61
    (64%) examined wrists
    Results
    • Another finding of interest in our study involves a particular
    fracture of the scaphoid bone. Of the 16 scaphoid fractures
    detected on CT by retrospective consensus, 25% (4/16) were
    dorsal avulsion fractures of the scaphoid. As indicated by
    Compson et al. and verified by our results, the scaphoid dorsal
    avulsion fracture is visible only on the 45° anteroposterior
    semisupinated oblique radiographic view of the scaphoid.
    Results
    • In the proximal carpal row, lunate and triquetrum fractures
    were often radiographically occult (0% and 20%, respectively,
    detected at radiography); whereas in the distal carpal row,
    trapezoid, capitate, and hamate fractures were often occult
    (0%, 0%, and 40% detected at radiography, respectively).
    Hamate fractures were significantly associated with
    metacarpal fractures, and distal radius fractures were
    associated with scaphoid and ulna fractures.
    CONCLUSION

    Radiography failed to detect 30% of wrist fractures


    identified at CT, which suggests the importance of
    further advanced or cross-sectional imaging for
    fracture detection in the correct clinical scenario.

    The location of a dorsal scaphoid avulsion fracture


    emphasizes the need for specific radiographic views
    or cross-sectional imaging for fracture detection.

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