Clinical impact of MRI in acute wrist injuries. Indication and therapeutic consequences

Abstract

This prospective study was aimed at evaluating the clinical impact of magnetic resonance imaging (MRI) vs conventional radiographs in the early diagnosis of acute wrist fractures. The influence of MRI on the period of being unable to work was demonstrated. MRI was performed within a mean of 6.6 days after initial radiographs in 54 patients (56 wrists) with clinical suspicion of wrist fractures and normal plain or indistinct radiographs. MRI findings were read without knowledge of the initial radiographs. In 31 of 56 wrists MRI findings resulted in a change of diagnosis. There was a false positive diagnosis on plain radiographs in nearly one-half ( n=25) of the cases,whereas only six cases had false negative results. In 28 cases MRI allowed the detection of additional injuries of soft tissues. In 35 of 56 cases radiological follow-up was no longer necessary. In 22 of 54 patients the period of immobilization could be shortened or treatment discontinued ( n=18). The period of being unable to work was shortened in 16 of 54 patients, while in 7 of 54 patients this time span had to be prolonged for therapeutic reasons. In 31 of 54 patients MRI-based therapeutic consequences had no influence on the period of being unable to work. Our results show a high clinical impact of MRI in the detection of acute wrist fractures. Early MRI is able to reduce economic costs due to efficient therapeutic treatment and shortened periods of being unable to work. We recommend MRI immediately on the day of trauma in the presence of clinical suspicion and equivocal plain radiographs