AN ALGORITHM FOR ACUTE WRIST TRAUMA - A SYSTEMATIC-APPROACH TO DIAGNOSIS

A systematic approach to the acute traumatized wrist is of importance to achieve early diagnosis, with efficient use of advanced imaging mod alities. In a 6-month period 641 patients aged 15 years or over were e xamined using an algorithm for acute wrist trauma in order to secure e arly and appropriate treatment. In 293 (46%) cases routine radiographi c examination supplied sufficient information to establish a fracture diagnosis. All 33 scaphoid fractures (including five scaphoid non-unio ns) were demonstrated on the initial X-ray examination. In 56 patients (9%) scintigraphy proved useful for selecting cases in need of furthe r radiographic examination. Among 31 patients with focal activity on b one scintigraphy, CT and/or tomography revealed eight distal radial fr actures, one fracture of the ulnar styloid, and eight fractures of car pal bones. Fractures were revealed using tomography and/or ''hot spot views'' in patients with negative CT examinations suggesting that furt her examinations should be performed in cases with increased focal act ivity on bone scintigraphy and a negative CT examination.