The usefulness of CT for patients with carpal bone fractures in the emergency department.
OBJECTIVE
The wrist is the most commonly injured joint in the body. However, wrist injuries are often missed in the emergency department (ED). If the fracture is not diagnosed and remains untreated, the patient runs a considerable risk of chronic disability. The utility of CT as an aid in the diagnosis of carpal bone fracture was investigated.


METHODS
A retrospective analysis was performed of patients who underwent CT and plain radiography for wrist injury in the ED between March 2003 and February 2006. Plain radiograph interpretations were classified into three groups: (1) the definite fracture group, (2) the no fracture group, and (3) the ambiguous fracture group. The CT results were analysed in relation to the classification of the plain radiograph interpretation. The final diagnoses reviewed from the medical records were used as the reference standard.


RESULTS
36 carpal fractures in 33 patients were identified from 45 patients who underwent plain radiography and CT. The interpretations of plain radiographs were classified into definite fractures (n = 10), ambiguous fractures (n = 15) and no fractures (n = 20). When both the definite fracture and ambiguous fracture groups were considered positive, the sensitivity and specificity were 69.7% and 83.3%, respectively. The sensitivity and specificity of CT scans were both 100%.


CONCLUSIONS
Emergency physicians should consider CT of the wrist after plain radiography when patients with suspected carpal fracture show normal radiographic findings.
You
Je Sung
JS
Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Chung
Sung Pil
SP
Chung
Hyun Soo
HS
Park
In Cheol
IC
Lee
Hahn Shick
HS
Kim
Seung Ho
SH
D000293:Adolescent; D000328:Adult; D000368:Aged; D002348:Carpal Bones / Q000000981:diagnostic imaging* / Q000293:injuries*; D004636:Emergency Service, Hospital; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*