Penetrating volar injuries of the hand: diagnostic accuracy of US in depicting soft-tissue lesions.
OBJECTIVE
To evaluate the effectiveness of ultrasonography (US) in depicting lesions of the tendons, arteries, and nerves caused by penetrating wounds of the volar aspect of the hand, with surgical exploration as the reference standard.


METHODS
Consecutive patients seen at one center over a 2-month period in 2006 were prospectively included. The institutional review board approved the study, and each patient gave written informed consent. There were 30 injuries in 26 patients (19 men and seven women; median age, 34 years). US examination was performed before surgery. Surgeons were not informed of the US findings. For tendons, arteries, and nerves, the sensitivity, specificity, positive predictive value, and negative predictive value of US were computed.


RESULTS
US depicted all tendon lesions, with no false-positive findings; two arterial lesions were missed, with no false-positive findings, and four nerve lesions were missed, with six false-positive findings. The negative predictive value was 100% (95% confidence interval: 95.5%, 100%) for tendons, 96.7% (95% confidence interval: 88.7%, 99.6%) for arteries, and 93.7% (95% confidence interval: 84.5%, 98.2%) for nerves. In three cases, US depicted foreign bodies missed at surgery.


CONCLUSIONS
US was highly effective in identifying patients with no tendon or arterial lesions. Performance was poorer for diagnosing nerve lesions. US followed by a repeat physical examination after 72 hours to look for missed nerve damage may deserve evaluation as an alternative to routine surgical exploration when US findings are normal.
Soubeyrand
Marc
M
Department of Radiology, Saint Antoine Hospital, Public Assistance Hospital of Paris, Paris, France. soubeyrand.marc@wanadoo.fr
Biau
David
D
Jomaah
Nabil
N
Pradel
Clément
C
Dumontier
Christian
C
Nourissat
Geoffroy
G
D000328:Adult; D001158:Arteries / Q000293:injuries; D005260:Female; D006230:Hand Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D059348:Peripheral Nerve Injuries; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013708:Tendon Injuries / Q000000981:diagnostic imaging; D018608:Ultrasonography, Doppler; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging*