Skip to main content
SpringerLink
Log in

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

Emergency Radiology Aims and scope Submit manuscript

Cite this article

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Chung KC, Spilson SV (2001) The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg [Am] 26(5):908–915

    Article  CAS  Google Scholar 

  2. Kaewlai R, Avery LL, Asrani AV, Abujudeh HH, Sacknoff R, Novelline RA (2008) Multidetector CT of carpal injuries: anatomy, fractures, and fracture-dislocations. Radiographics 28(6):1771–1784

    Article  PubMed  Google Scholar 

  3. Geijer M, El-Khoury GY (2006) MDCT in the evaluation of skeletal trauma: principles, protocols, and clinical applications. Emerg Radiol 13(1):7–18

    Article  PubMed  Google Scholar 

  4. Obermann WR (1996) Wrist injuries: pitfalls in conventional imaging. Eur J Radiol 22(1):11–21

    Article  CAS  PubMed  Google Scholar 

  5. Welling RD, Jacobson JA, Jamadar DA, Chong S, Caoili EM, Jebson PJ (2008) MDCT and radiography of wrist fractures: radiographic sensitivity and fracture patterns. Am J Roentgenol 190(1):10–16

    Article  Google Scholar 

  6. Kiuru MJ, Haapamaki VV, Koivikko MP, Koskinen SK (2004) Wrist injuries; diagnosis with multidetector CT. Emerg Radiol 10(4):182–185

    Article  PubMed  Google Scholar 

  7. Pierre-Jerome C, Moncayo V, Albastaki U, Terk MR (2010) Multiple occult wrist bone injuries and joint effusions: prevalence and distribution on MRI. Emerg Radiol 17(3):179–184

    Article  PubMed  Google Scholar 

  8. Brydie A, Raby N (2003) Early MRI in the management of clinical scaphoid fracture. Br J Radiol 76(905):296–300

    Article  CAS  PubMed  Google Scholar 

  9. Memarsadeghi M, Breitenseher MJ, Schaefer-Prokop C, Weber M, Aldrian S, Gäbler C, Prokop M (2006) Occult scaphoid fractures: comparison of multidetector CT and MR imaging—initial experience. Radiology 240(1):169–176

    Article  PubMed  Google Scholar 

  10. Platon A, Poletti PA, Van Aaken J, Fusetti C, Della Santa D, Beaulieu JY, Becker CD (2011) Occult fractures of the scaphoid: the role of ultrasonography in the emergency department. Skeletal Radiol 40(7):869–875

    Article  PubMed  Google Scholar 

  11. Hove LM (1999) Epidemiology of scaphoid fractures in Bergen, Norway. Scand J Plast Reconstr Surg Hand Surg 33(4):423–426

    Article  CAS  PubMed  Google Scholar 

  12. van Onselen EB, Karim RB, Hage JJ, Ritt MJ (2003) Prevalence and distribution of hand fractures. J Hand Surg (Br) 28(5):491–495

    Article  Google Scholar 

  13. Low G, Raby N (2005) Can follow-up radiography for acute scaphoid fracture still be considered a valid investigation? Clin Radiol 60(10):1106–1110

    Article  CAS  PubMed  Google Scholar 

  14. Hunter JC, Escobedo EM, Wilson AJ et al (1997) MR imaging of clinically suspected scaphoid fractures. Am J Roentgenol 168:1287–1293

    Article  CAS  Google Scholar 

  15. Hey HW, Chong AK, Murphy D (2011) Prevalence of carpal fracture in Singapore. J Hand Surg [Am] 36(2):278–283

    Article  Google Scholar 

  16. Packer GJ, Shaheen MA (1993) Patterns of hand fractures and dislocations in a district general hospital. J Hand Surg (Br) 18(4):511–514

    Article  CAS  Google Scholar 

  17. Duckworth AD, Jenkins PJ, Aitken SA, Clement ND, Court-Brown CM, McQueen MM (2012) Scaphoid fracture epidemiology. J Trauma 72(2):41–45

    Google Scholar 

  18. Diamantopoulos AP, Rohde G, Johnsrud I, Skoie IM, Hochberg M, Haugeberg G (2012) The epidemiology of low- and high-energy distal radius fracture in middle-aged and elderly men and women in Southern Norway. PLoS One 7(8):e43367

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  19. Ilica AT, Ozyurek S, Kose O, Durusu M (2011) Diagnostic accuracy of multidetector computed tomography for patients with suspected scaphoid fractures and negative radiographic examinations. Jpn J Radiol 29(2):98–103

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Radiology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey

    Ali Balci, Işıl Basara, Ertuğ Yasin Çekdemir, Filiz Tetik, Gülşah Aktaş & Dinç Özaksoy

  2. Department of Emergency Medicine, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey

    Aslı Acarer

Authors
  1. Ali Balci
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Işıl Basara
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ertuğ Yasin Çekdemir
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Filiz Tetik
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gülşah Aktaş
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Aslı Acarer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dinç Özaksoy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ali Balci.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Balci, A., Basara, I., Çekdemir, E.Y. et al. Wrist fractures: sensitivity of radiography, prevalence, and patterns in MDCT. Emerg Radiol 22, 251–256 (2015). https://doi.org/10.1007/s10140-014-1278-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10140-014-1278-1

Keywords

search

Navigation