Medical imaging performed by the surgeon in a private hand surgery setting. A new radio-clinical concept

Abstract

In an outpatient private hand surgery setting, the usefulness of radiological controls during the consultation is not to be proven anymore. This allows early diagnosis of a fracture for example and an immediate treatment without delay. Ultrasound performed by the hand surgeon has also been developed in recent years, in effect, this allows for a more accurate diagnosis in different pathological situations (carpal tunnel recurrence after surgery, ganglion cyst, rupture of a digital pulley, vascular thrombosis, fractures, Stener lesions…). We have been using echography since 2008. The emergence of Cone beam CT-scan mainly used in dental practice for implant surgery and for dental surgery, which allows precise calculations and especially ultra low radiological doses well below the conventional CT scan. This type of CT scan was implemented at the hand clinic, this allows the surgeon to refine diagnosis and especially to take more accurate and faster surgical decisions. The cone beam CT has been used since January 2015 in our unit. Regarding ultrasound, lesions are readily accessible to the surgeon and because surgery allows radiological correlation. This is particularly true for tendon surgery, preoperative diagnosis of lesions, postoperative follow-up, it is also possible to follow with X-ray or ultrasound Silastic rods and tendon anastomoses. An additional Cone Beam CT will confirm lesions or fractures not detected by conventional X-ray like, joint damage at the radio-carpal level, radio-ulnar joint, fracture of the hook of the hamate or of the pisiform, radio-carpal osteoarthritis… In conclusion, the radiological techniques in hand and wrist surgery of are now available to the surgeon through appropriate training in radioprotection, radiology, ultrasound and also use of the cone Beam CT scan.