Synopsis
This presentation is a brief overview of the magnetic resonance imaging appearance of wrist fractures and their complications. The diagnostic criteria for avascular necrosis and advanced imaging techniques will be discussed.Highlights
Injuries to the wrist are common and typically result from a fall on an outstretched hand (FOOSH) injury. While conventional radiography is still the first line imaging tool for diagnosis of traumatic injuries of the wrist, radiographically occult fractures are common. The objectives of this talk include a brief review of anatomy of the wrist and show examples of traumatic injuries of the distal radius and carpal bones as well as their potential complications on magnetic resonance imaging studies.
Target Audience
The clinical radiologist will benefit from lecture as it will provide examples of traumatic injuries which could potentially be missed by radiographs.
Purpose
Conventional radiography is the first line imaging tool in the setting of wrist trauma, however, fractures of the carpal bones or the distal radius could be radiographically occult. The current standard of care includes radiography at the time of presentation. If the initial radiographs are normal, repeat imaging after 7-10 days of immobilization is recommended. This could potentially lead to a delay in diagnosis and potentially lost wages and increase in sick leave for the patient. Magnetic resonance imaging at the time of presentation has been shown to increase the sensitivity for the detection of traumatic injuries leading to earlier treatment.
Outline
This lecture will review the magnetic resonance imaging appearance of fractures of the carpal bones, distal radius, and the distal ulna. Of the carpal bones, the most commonly injured is the scaphoid. I will review the unique anatomy and vascular supply of the scaphoid and show how it plays a role in healing and potential complications including avascular necrosis. Also, I will introduce and discuss the pros and cons of various magnetic resonance imaging techniques to image the scaphoid to assess viability and help with surgical planning. Lastly, I will review potential complications of carpal bone and distal radial fractures.
Conclusion
Imaging appearance of the most common fractures of the wrist.
Review the sensitivity and specificity of T1, T2 FS/STIR, delayed post contrast, and dynamic post contrast imaging in the setting of scaphoid fractures.
Familiarize the audience with potential complications of carpal bone and distla radial fractures.
Acknowledgements
Special thanks to Dr. Eric Y. Chang for help with preparation of the lecture.References
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Bervian MR, Ribak S, Livani B. Scaphoid fracture nonunion: correlation of radiographic imaging, proximal fragment histologic viability evaluation, and estimation of viability at surgery: diagnosis of scaphoid pseudarthrosis. Int Orthop. 2015 Jan;39(1):67-72.
Jarraya M, Hayashi D, Roemer FW et al. Radiographically Occult and Subtle Fractures:
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Murthy NS and Ringler MD. MR Imaging of Carpal Fractures. Magnetic Resonance Imaging Clinics of North America. 2015; 23: 405-416.
Pierre-Jerome C, Moncayo V, Albastaki U, Terk M. Multiple occult wrist bone injuries and joint effusions: prevalence and distribution on MRI. 2010; 3 (17): 179-184.