title: Determination of radiography requirement in wrist trauma.
abstract: OBJECTIVE
  The purpose of this study was to evaluate predetermined physical examination and function tests recommended to identify severe injury among patients presenting with wrist injury to the emergency department and to establish a reliable clinical decision rule capable of determining the need for radiography in wrist injuries.
  
  
  METHODS
  This was a multicenter prospective derivation study of wrist injuries. All patients were assessed in terms of mechanism of trauma, inspection findings, heart rate, sensitivity at palpation, presence of pain with active movement, grasp strength, and functional tests using an examination form under main headings. Sensitivity, specificity, and positive and negative predictive values were expressed for each sign and each examination finding.
  
  
  RESULTS
  One hundred nineteen adult patients were enrolled during the 6-month study period. Fracture was identified in 24.3% (n = 29). Presence of pain on the radial deviation, dorsal flexion, distal radioulnar drawer, and axial compression tests exhibited high sensitivity (82.8%, 89.7%, 82.8%, and 86.2%, respectively) and high negative predictive values (88.6%, 81.3%, 87.5%, and 93.6%, respectively) for wrist fracture. Sensitivity of 96.6% was observed when these 4 tests were evaluated together.
  
  
  CONCLUSIONS
  The presence of one of these examination findings increases the likelihood of fracture and is adequate to recommend wrist radiography. In addition, there is a strong possibility of radiography being unnecessary if all 4 test results are negative in patients presenting with wrist injury, potentially preventing many nonessential radiographs being performed.
authors.affiliation: Karadeniz Technical University, Faculty of Medicine, Department of Emergency Medicine, Trabzon, Turkey. Electronic address: drsuhaturkmen@hotmail.com.
authors.forename: Suha
authors.initials: S
authors.lastname: Turkmen
authors.affiliation: Karadeniz Technical University, Faculty of Medicine, Department of Radiology, Trabzon, Turkey.
authors.forename: Aysegul
authors.initials: A
authors.lastname: Cansu
authors.affiliation: Karadeniz Technical University, Faculty of Medicine, Department of Emergency Medicine, Trabzon, Turkey.
authors.forename: Yunus
authors.initials: Y
authors.lastname: Karaca
authors.affiliation: Karadeniz Technical University, Faculty of Medicine, Department of Orthopaedics and Traumatology, Trabzon, Turkey.
authors.forename: Mehmet Emre
authors.initials: ME
authors.lastname: Baki
authors.affiliation: Kırıkkale University, Faculty of Medicine, Department of Emergency Medicine, Kırıkkale, Turkey.
authors.forename: Oguz
authors.initials: O
authors.lastname: Eroglu
authors.affiliation: Kanuni Training and Research Hospital, Department of Emergency Medicine, Trabzon, Turkey.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Tatli
authors.affiliation: Giresun University, Faculty of Medicine, Department of Emergency Medicine, Giresun, Turkey.
authors.forename: Mucahit
authors.initials: M
authors.lastname: Gunaydin
authors.affiliation: Karadeniz Technical University, Faculty of Medicine, Department of Public Health, Trabzon, Turkey.
authors.forename: Ercument
authors.initials: E
authors.lastname: Beyhun
authors.affiliation: Karadeniz Technical University, Faculty of Medicine, Department of Emergency Medicine, Trabzon, Turkey.
authors.forename: Abdulkadir
authors.initials: A
authors.lastname: Gunduz
authors.affiliation: Karadeniz Technical University, Faculty of Medicine, Department of Emergency Medicine, Trabzon, Turkey.
authors.forename: Suleyman
authors.initials: S
authors.lastname: Turedi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D005260:Female; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D010808:Physical Examination; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular; D015203:Reproducibility of Results; D014954:Wrist Injuries / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D055815:Young Adult