The Utility Of Routine Radiographic Imaging In Acute Hand Injuries: A Retrospective Study
Minh NQ Huynh, MD, Emily Dunn, HBSc, MSc, Forough Farrokhyar, MPhil, PhD, Sophocles Voineskos, MD, MSc.
McMaster University, Hamilton, ON, Canada.
Acute hand injuries are routinely referred for radiographic assessment to rule out clinically significant fractures. Despite its low cost, high volumes of x-rays can exceed costs from low-volume, high-resource modalities such as MRIs. The purpose of this study was to elucidate the utility of routine radiographic imaging for detecting clinically significant fractures in acute hand injuries.
A retrospective study was performed for patients 18 years of age or older presenting with an acute hand injury to a single hospital's emergency department in 2018. Patients were identified using International Classification of Disease (ICD-10) codes. Patients were classified into four groups: no fracture, non-clinically significant fracture that required no treatment, clinically significant fracture treated with non-operative management, and clinically significant fracture that required surgery. The primary outcome of the study was the presence of a fracture that required immobilization or surgical intervention.
In total, 417 patients presented with acute hand injuries, 188 of whom received radiographic imaging. Mean age of the patient cohort was 42 ± 18 years with a mean time to presentation of 2.0 ± 6.8 days. The most common mechanism of injury was blunt force (n=86) followed by falls (n=47) and combative injuries (n=21). More than two-thirds of patients (n=128, 69%) either had no fracture (n=119, 63%) or a non-clinically significant fracture (n=10, 5%). No complications were reported for non-clinically significant fractures. Fifty-nine patients had a fracture that was either treated with conservative management (n=45, 24%) or surgical fixation (n=14, 7%).
The utility of routine x-rays for acute hand injuries remains equivocal. The majority of patients with acute hand injuries did not have a clinically significant fracture. Clearer indications for radiographic imaging in acute hand injuries might help to improve the efficacy of diagnostic x-rays.
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