Wounds and Injuries, Wrist Injuries
Conditions
Keywords
Radius fracture, Scaphoid fracture, Tomography, x-ray computed
Brief summary
The purpose of this study is to evaluate whether standard volume computed tomography (CT) has impact on treatment in patients with suspicion of fractures of the wrist and carpus.
Interventions
RADIATIONVolume Computed Tomography of the wrist and carpus
Sponsors
Radboud University Medical Center
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients (18 years and older) who are referred to our hospital for conventional radiography of the wrist and carpus * Recent trauma mechanism (within 3 days before presentation) * Clinical suspicion of fractures of the wrist and carpus. The carpus includes all carpal bones, but does not include the metacarpal bones.
Exclusion criteria
* Patients who were not evaluated by a clinician before imaging was performed. * Open fractures * No informed consent or no prospective data collection could be obtained. Informed consent cannot be obtained in case patients do not speak or understand Dutch. * Patients who cannot be positioned in upright position, immobilized on a spine board or transferred to the intensive care unit and cannot undergo upright CT
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of patients with prospectively documented treatment changes after CT | within same visit (i.e. in one day) | This endpoint is defined as presence of difference in predefined treatment regimens before and after CT. These regimens include: -Conservative treatment on the emergency ward (functional, immobilization with bandage, cast, or closed reduction and cast), closed operative treatment (reduction and cast on operation room, percutaneous pinning, or external fixation), open surgical treatment (dorsal, radial, or palmar exposure with reduction and internal fixation). Additional regimens include: Second opinion from a colleague or consulting a different specialism. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Diagnostic performance of CT and conventional radiography (CR) for fracture pattern | within the same visit (one day) | Fracture patterns are classified according to presence and type of fractured bones, presence of intra-articular components of distal radius fractures (including sigmoid notch involvement), presence of (fracture) dislocation or avulsion fractures of carpal bones. Standard of reference is presence of injuries at imaging, at surgery, and disability complains at 1-year follow up. In case of discrepancy, consensus will be reached at the end of the study by a panel of trauma surgeons and radiologists. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Radiological feasibility | Within an average of three days after CT | Image quality (5-point scale), artifacts (5-point scale) noise (standard deviation Hounsfield Units), radiation dose, and presence of technical problems |
| Patient outcome: Pain and disability | one year | Pain and disability according to the Patient rated wrist and hand evaluation (PRWHE) score 6 weeks, 6 months, and 12 months after trauma |
Countries
Netherlands
Outcome results
None listed