Detection of fractures of hand and forearm in whole-body CT for suspected polytrauma in intubated patients

Abstract

Background: The aim of this study was to evaluate the potential of whole-body CT for diagnosis of hand and forearm fractures in intubated patients with suspected polytrauma. Methods: We performed a retrospective analysis on data collected from two trauma centres in Germany, including demographics, ISS, clinical symptoms, depiction in whole-body CT, and time to diagnosis. Results: Out of 426 patients included in the study, 66 (15.5%) suffered a hand or forearm fracture. The total number of fractures was 132, the whole-body CT report mentioned 98 (74.2%). 16 (12,1%) fractures of 12 patients were diagnosed later than 24 h after admission. Late diagnoses of fractures of the hand occurred more often if the hand was not fully included in the CT scan field. The sensitivity of whole-body CT for cases with fractures of hand and/or forearm with full inclusion of the corresponding area in the scan field was 80.2%. Conclusions: This study shows that whole-body CT is a valuable diagnostic tool for hand fractures in polytrauma patients. Hands should be evaluated regardless of clinical presentation in intubated patients after suspected polytrauma if they are included in the whole-body CT.

Detection of Missed Fractures of Hand and Forearm in Whole-Body CT in a Blinded Reassessment

“…We found that fractures of hand are more often detected in patients in cases with full inclusion of the hand in the wholebody CT (WBCT). This was more often achieved by placing the hands on the abdomen [6]. The ISS did not have an influence on the number of late diagnoses in our sample [6].…”

“…While there is no definition of 'missed', delayed', or 'late', we decided to use the term 'late diagnosis' for injuries that were detected 24 h after admission but during hospitalisation as they were eventually found [3][4][5][6]. Fractures of the upper extremity may be associated with reduced quality of life [7][8][9].…”

Detection of missed fractures of hand and forearm in whole-body CT in a blinded reassessment

“…Injuries of the hand may be missed in 3.5 to 25% of patients with polytrauma [ 1 , 2 ]. While there is no definition of ‘missed’, delayed’, or ‘late’, we decided to use the term ‘late diagnosis’ for injuries that were detected 24 h after admission but during hospitalisation as they were eventually found [ 3 – 6 ]. Fractures of the upper extremity may be associated with reduced quality of life [ 7 – 9 ].…”

“…We found that fractures of hand are more often detected in patients in cases with full inclusion of the hand in the whole-body CT (WBCT). This was more often achieved by placing the hands on the abdomen [ 6 ]. The ISS did not have an influence on the number of late diagnoses in our sample [ 6 ].…”

“…This was more often achieved by placing the hands on the abdomen [ 6 ]. The ISS did not have an influence on the number of late diagnoses in our sample [ 6 ]. The question remained if the fractures are visible for the human eye on retrospection which may also depend on the slice thickness of the WBCT.…”