Enhancing Hand Trauma Diagnosis: Analysis of Cone Beam CT Versus Plain Radiography
cone beam computed tomography; CBCT; scaphoid fracture; wrist trauma; hand trauma; radiography; fracture detection
AuthorsAbstractBackground/Objectives: The detection of hand trauma, particularly scaphoid fractures, is challenging because of the intricate composition of the wrist bones. Standard radiography has recognized limitations and may fail to identify occult fractures at the initial presentation. This study compared the diagnostic yield of cone beam computed tomography (CBCT) versus plain radiography for suspected scaphoid and other wrist fractures in a preliminary exploratory cohort. Methods: This prospective, single-center exploratory study included a convenience sample of 31 patients with suspected hand and wrist injuries. After initial radiography, patients underwent CBCT. Two blinded radiologists independently reviewed both image sets. The primary outcome was the comparative fracture detection rate between the two modalities. Results: CBCT demonstrated a higher diagnostic yield, identifying fractures in 20/31 patients (64.5%; 95% CI: 46.9%-78.9%) compared with 12/31 patients (38.7%; 95% CI: 23.7%-56.2%) by radiography. This difference was statistically significant (McNemar's test, p = 0.0078). CBCT identified eight fractures that were not detected by radiography and eliminated diagnostic ambiguity, with 0% of cases classified as suspicious compared with 12.9% for radiography. Conclusions: In this preliminary study, CBCT showed a higher diagnostic yield for occult hand and wrist fractures than plain radiography. These findings support the potential value of CBCT as a second-line imaging tool when clinical suspicion remains high despite negative or equivocal radiographs. Larger multi-center studies with a definitive reference standard are needed to confirm these findings. 1. Introduction Hand injuries are among the most frequently encountered cases in emergency departments, accounting for approximately 10 to 30% of injuries seen in such settings [1]. Radiography remains the primary imaging modality for diagnosing these injuries as it provides vital information for the initial management of patients [2]. Due to the hand’s pivotal role in both functional and social activities, injuries to this area require prompt and expert care [3]. The psychological burden caused by hand injuries, such as depression and anxiety, can significantly reduce a patient’s quality of life [4]. While simple radiographs can diagnose many hand and wrist injuries, certain cases, especially non-displaced fractures like scaphoid fractures, present diagnostic challenges. These fractures, which are often subtle and difficult to detect with standard radiographs, can lead to poor outcomes if not accurately diagnosed [5]. •••••••••••••••••••••••••••••••• ejprd.org- Published by Riset Publishing Services LLC.
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