Multidetector CT of Carpal Injuries: Anatomy, Fractures, and Fracture-Dislocations

Abstract

Fractures and dislocations of the carpal bones are more common in young active patients. These injuries can lead to pain, dysfunction, and loss of productivity. Conventional radiography remains the primary imaging modality for evaluation of suspected carpal fractures and dislocations. However, multidetector computed tomography (CT) is playing an increasingly important role, especially in the following situations: (a) when results from initial radiographs are negative in patients with suspected carpal fractures, (b) when initial radiographic findings are indeterminate, and (c) when knowledge of the extent of carpal fractures or dislocations is required before surgical treatment. The advantages of multidetector CT include quick and accurate diagnosis with availability in most emergency centers. Multidetector CT can easily display the extent of carpal fractures and dislocations, often depicting fractures that are occult at radiography. In addition, with multiplanar (two-dimensional) and volumetric (three-dimensional) reformation, pathologic conditions and anatomic relationships are better perceived. This information can be easily conveyed to orthopedic and trauma surgeons and can be crucial for surgical treatment and planning.

Lunate dislocation causing median nerve entrapment

“…It represents the final stage of perilunate injury and is associated with the highest degree of wrist instability. 3 A careful clinical and radiographic assessment is imperative to diagnose this condition, which can often be missed or the diagnosis delayed leading to chronic disability and pain.…”

“…It is considered to represent stage IV of perilunate instability. 3 A thorough clinical evaluation and imaging play a vital role in the evaluation of these injuries, which often go unrecognised and untreated in the emergency set up, resulting in chronic disability and pain. In a multicentre study by Herzberg et al missed diagnosis has been reported in up to 25% of cases.…”

How Much Pain Is Necessary To Get Computed Tomography For Fracture Diagnosis Of The Wrist Injury That Can Not Be Radiographically Detectable?

“…VAS skor değeri farkının e noktasında saptanmasına ragmen (2,6) , e noktasının herhangi bir kı-rık için özgüllüğü yüksek bulunmadı. E noktasında da 7 ve üzerinde VAS değeri olan hastalar dikkate alındıgında (4 hasta), %100 olarak kırık oranı göz-lendi.…”

“…Konvansiyonel grafiler ile 8 farklı şekil ve karmaşık 3 boyutlu ilişkisi olan bu kemiklerin bazı kırıkları gözden kaçırılabilir. Süper-pozisyon olması, optimal konumlandırmanın kişiye bağlı oluşu nedenleri düz radyografi kullanımının olumsuz yönleridir (2)(3)(4) . Tanı konulamamış ortopedik patolojiler, özellikle de kırık/çıkıklar kötü ve yetersiz uygulama (malpraktis) iddialarının en önemli kaynaklarından biridir.…”

Stress Fracture of the Capitate

“…Due to its anatomical location, it is well-protected such that capitate fracture rarely occurs, accounting for only 1-3% of all carpal fractures (2). Most capitate fractures are associated with other carpal injuries, such as scaphoid fractures and perilunate injuries.…”