The ultrasonography examination for acute injury of the wrist with normal X rays: A monocentric prospective study of 16 wrists

Abstract

Ultrasonography is a simple, comparative, easy, cheap examination with no undesirable effects. However, this technique is not systematically used to diagnose a recent wrist pain when X rays are normal. The aim of this study is to evaluate a new ultrasonography procedure to diagnose five important damages. Five simple ultrasonographic views are performed by the orthopedic surgeon for these five structures the scaphoid (fracture), the scapholunate ligament (sign of the protrusion of capitate), the radio-carpal capsule (hemarthrosis), the triangular fibrocartilage complex (edema or hemarthrosis) and the median nerve (compression or intraneural contusion). During 6 months, 8694 patients have been welcomed in the emergency room and 271 had a wrist or hand pain. Sixteen adults’ patients (8 males and 8 females, age 18–58, mean 36 years old) with a recent injury of the wrist, no history of trauma of the wrists, and normal radiological examination were included in a prospective study. All the patients have been examined by the author clinically and ultrasonographically between day 8 and day 15. All the diagnosis and treatments were 1 scaphoid fracture (treated by percutaneous screw), 1 scapholunate tear (ligamentoplasty under an arthroscopic technique), 6 dorsal capsular rupture (splint), 4 lesions of the TFCC (conservative treatment) 3 lesions of the ulnar nerve in the Guyon tunnel (conservative treatment), and 1 median nerve lesion (steroid injection). For all the pathologies of ligaments or bones at the wrist or carpus, there are a lot of reports of the ultrasound examination in literature. However, there is no prospective study of the population with painful wrists and normal X-rays, usually classified in the unclear diagnosis of sprain of the wrist. A protocol called focused assessment with sonography for trauma (FAST) already exists for surgery and emergency medicine. Our protocol is the first one for a special joint. This procedure performed by the orthopedic surgeon permitted to make a precise diagnosis of wrist injury for all the patients for a fast decision to operate or not. There is no protocol shoulder or ankle which ultrasound can be very useful.