For phalangeal injuries, some centers include a PA examination of the entire hand, whereas others limit the examination to the injured finger. An internally rotated oblique projection, in addition to the standard externally rotated oblique, increases diagnostic yield for phalangeal fractures [15]. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Acute Hand and Wrist Trauma Most fractures of the thumb are visible on a 2-view radiographic examination, although there is a slight increase in diagnostic yield with the addition of an oblique projection [13], which can be obtained along with a PA examination of the whole hand. CT Area of Interest In patients with intra-articular fractures seen on radiography, CT shows articular fracture fragment displacement, depression, and comminution more accurately than conventional radiographs [7,9,10]. CT measurements of articular surface gap and step-off are more reproducible than radiographs [7]. The addition of 3-D surface- rendered reconstructions to the standard 2-D CT images has been shown to change operative management in up to 48% of intra-articular distal radius fractures [8]. There is no evidence to support the use of CT with intravenous (IV) contrast in the setting of acute hand and wrist trauma. MRI Area of Interest MRI is not indicated initially in this clinical setting. US Area of Interest US is not indicated initially in this clinical setting. Bone Scan Area of Interest Bone scan is not indicated in this clinical setting. Variant 2: Suspect acute hand or wrist trauma. Initial radiographs negative or equivocal. Next imaging study.
Acute Hand and Wrist Trauma. For phalangeal injuries, some centers include a PA examination of the entire hand, whereas others limit the examination to the injured finger. An internally rotated oblique projection, in addition to the standard externally rotated oblique, increases diagnostic yield for phalangeal fractures [15]. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Acute Hand and Wrist Trauma Most fractures of the thumb are visible on a 2-view radiographic examination, although there is a slight increase in diagnostic yield with the addition of an oblique projection [13], which can be obtained along with a PA examination of the whole hand. CT Area of Interest In patients with intra-articular fractures seen on radiography, CT shows articular fracture fragment displacement, depression, and comminution more accurately than conventional radiographs [7,9,10]. CT measurements of articular surface gap and step-off are more reproducible than radiographs [7]. The addition of 3-D surface- rendered reconstructions to the standard 2-D CT images has been shown to change operative management in up to 48% of intra-articular distal radius fractures [8]. There is no evidence to support the use of CT with intravenous (IV) contrast in the setting of acute hand and wrist trauma. MRI Area of Interest MRI is not indicated initially in this clinical setting. US Area of Interest US is not indicated initially in this clinical setting. Bone Scan Area of Interest Bone scan is not indicated in this clinical setting. Variant 2: Suspect acute hand or wrist trauma. Initial radiographs negative or equivocal. Next imaging study.