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Incidence and underreporting of osseous wrist and hand injuries on whole-body computed tomographies at a level 1 trauma center.
Schmehl, L; Hönning, A; Asmus, A; Kim, S; Mutze, S; Eisenschenk, A; Goelz, L.
Afiliação
  • Schmehl L; Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany.
  • Hönning A; Center for Clinical Research, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany.
  • Asmus A; Department of Hand-, Replantation- and Microsurgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany.
  • Kim S; Department of Hand Surgery and Microsurgery, University Medicine Greifswald, Greifswald, Germany.
  • Mutze S; Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany.
  • Eisenschenk A; Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany.
  • Goelz L; Department of Hand-, Replantation- and Microsurgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany.
BMC Musculoskelet Disord ; 22(1): 866, 2021 Oct 11.
Article em En | MEDLINE | ID: mdl-34635079
ABSTRACT

BACKGROUND:

To investigate the incidence of osseous wrist and hand injuries on whole-body computed tomographies (WBCT) at an urban maximum-care trauma center, to report the number of missed cases in primary radiology reports, and to develop an algorithm for improved detection of these injuries.

METHODS:

Retrospective analysis reviewing all WBCT for a period of 8 months for osseous wrist and hand injuries. (1) Reconstruction of hands/wrists in three planes (thickness 1-2 mm) and analysis by a blinded musculoskeletal radiologist. (2) Scanning of primary radiology reports and comparison to the re-evaluation. (3) Calculation of the diagnostic accuracy of WBCT during primary reporting. (4) Search for factors potentially influencing the incidence (trauma mechanism, associated injuries, Glasgow Coma Scale, artifacts). (5) Development of an algorithm to improve the detection rate.

RESULTS:

Five hundred six WBCT were included between 01/2020 and 08/2020. 59 (11.7%) WBCT showed 92 osseous wrist or hand injuries. Distal intra-articular radius fractures occurred most frequently (n = 24, 26.1%); 22 patients (37.3%) showed multiple injuries. The sensitivity of WBCT in the detection of wrist and hand fractures during primary evaluation was low with 4 positive cases identified correctly (6.8%; 95% CI 1.9 to 16.5), while the specificity was 100% (95% CI 99.2 to 100.0). Forty-three cases (72.9%) were detected on additional imaging after clinical reassessment. Twelve injuries remained undetected (20.3%). Motorcycle accidents were more common in positive cases (22.0% vs. 10.1%, p = 0.006). 98% of positive cases showed additional fractures of the upper and/or lower extremities, whereas 37% of the patients without osseous wrist and hand injuries suffered such fractures (p < 0.001). The remaining investigated factors did not seem to influence the occurrence.

CONCLUSION:

Osseous wrist and hand injuries are present in 11.7% on WBCT after polytrauma. 93.2% of injuries were missed primarily, resulting in a very low sensitivity of WBCT during primary reporting. Motorcycle accidents might predispose for these injuries, and they often cause additional fractures of the extremities. Clinical re-evaluation of patients and secondary re-evaluation of WBCT with preparation of dedicated multiplanar reformations are essential in polytrauma cases to detect osseous injuries of wrist and hand reliably. TRIAL REGISTRATION The study was registered prospectively on November 17th, 2020, at the German register for clinical trials (DRKS-ID DRKS00023589 ).
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Punho / Traumatismos da Mão Idioma: En Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Punho / Traumatismos da Mão Idioma: En Ano de publicação: 2021 Tipo de documento: Article