MR Imaging of Carpal Fractures

Epidemiology of carpal fractures: is it only about the scaphoid?

Because of their low incidence, studies about carpal fractures are rare. The aim of the present study was to analyze epidemiology and treatment of fractured carpal bones. We retrospectively analyzed data of 178 patients admitted to our emergency room with carpal fractures over 6 years. More males than woman were injured. In 91%, a CT scan was performed. The most commonly affected bone was the triquetrum followed by the scaphoid. Almost all triquetral fractures were treated conservatively as opposed to perilunate dislocations that were all operated on. Half of all patients with scaphoid fractures were operated. Young men had the highest risk to sustain a carpal fracture. The triquetrum and the scaphoid are most frequently affected. Usually a CT scan is needed. Treatment of scaphoid and perilunate luxation fractures is rather operative whereas the other fractures mostly allow conservative casting. Nevertheless, correct indication for treatment is important to avoid sequelae.

Imaging Review of Hockey-Related Upper Extremity Injuries

Ice hockey is a fast-paced contact sport with a high incidence of injuries. Upper extremity injury is one of the most common regions of the body to be injured in hockey. This imaging review will equip the radiologist with a knowledge of the more common and severe upper extremity injuries that occur in this sport.

Acute Bony Injuries of Hand and Wrist

Acute bony injuries to the hand and wrist are very common after a fall on an outstretched hand. In the wrist, distal radius fractures are the most common; isolated distal ulna fractures are uncommon. More serious injuries to the wrist include complicated fracture-dislocation injuries such as perilunate dislocations. At the carpal level, scaphoid fractures are the most common followed by fractures of the dorsal side of the triquetrum. The metacarpals often fracture, most commonly the base of the thumb and the subcapital region of the fifth metacarpal. In the fingers, we encounter many different types of fractures, often avulsions reflecting underlying soft tissue pathology (e.g., mallet finger). Dislocations are common in the fingers, predominantly in the distal interphalangeal joints. From an imaging standpoint, conventional radiography is always the initial examination. Complex (intra-articular) fractures, fracture-dislocation injuries, and a strong clinical suspicion of radiographically occult fractures need to be further evaluated for decision making regarding treatment. Computed tomography is the primary imaging modality of choice for the first two. In the latter, magnetic resonance imaging can be preferable, depending on clinical suspicion and the local situation in the associated hospital.

Review article: the differential diagnosis of bone marrow edema on wrist MRI

There is a large variety of conditions that can result in 'bone marrow edema' or 'bone marrow lesions' (BML) in the wrist on magnetic resonance imaging (MRI). The combination of clinical history and the distribution of the BML can serve as a valuable clue to a specific diagnosis. This article illustrates the different patterns of BML in the wrist to serve as a useful guide when reviewing wrist MRI studies. Imaging artefacts will also be briefly covered.

Non-hip/non-vertebral fractures - How to treat best?

Fractures of the extremities in the elderly constitute more than two-thirds of all fragility fractures befalling frail, osteoporotic and sarcopenic patients. Although treatment controversies abound, consensus exists. Upper extremity fractures hinder activities of daily living and are debilitating. Open fractures or displaced fractures will need surgical intervention. Wrist fractures treated operatively allow early use of the hand. Most pelvic fractures are treated conservatively. In the lower extremities, fractures of the long bones, tibia and femur need surgical intervention. Non-displaced fractures around the foot may be treated with immobilisation and avoidance of full weight-bearing. As a rule, fractures take four months for consolidation. Individually tailored solutions are needed for frail patients with comorbidities. Maintaining joint mobility and muscle strength preserves mobility and autonomy. Caring for extremities trauma is team work, involving family and health care providers. Prevention efforts are mandatory.