Are oblique views needed for trauma radiography of the distal extremities?

To our knowledge, few studies exist on the importance of the oblique view when radiography of the distal extremities is performed after acute trauma. Our prospective study aimed to determine whether the oblique view uniquely revealed abnormalities or clarified findings when it was obtained along with routine frontal and lateral radiographs.

We prospectively interpreted 1461 consecutive radiographic examinations of the distal extremities in patients presenting with acute trauma to four family medicine clinics. The anatomic sites radiographed included the ankle, foot, toe, wrist, hand, finger, and thumb. Each study was interpreted and given a diagnostic certainty score using the lateral and posteroanterior or anteroposterior views only and then scored again with the oblique view added.

The examinations included 421 with abnormal findings, 34 with equivocal findings, and 1006 with normal findings. The addition of the oblique view changed the interpretation in 70 (4.8%) of the 1461 examinations. Of these changed interpretations, 39 were changed from equivocal to either positive or negative, three from positive to negative, and 28 from negative to positive. Addition of the oblique view increased diagnostic confidence: The percentage of examinations scored as having probably normal, equivocal, and probably abnormal findings decreased from 13.9% with two views to 8.4% with three views (p < .0001). The oblique view was equally valuable in the ankle, foot, toe, wrist, hand, finger, and thumb.

In the distal extremities, the oblique view uniquely reveals abnormalities and increases the confidence of the final radiographic diagnosis when the oblique view is interpreted along with frontal and lateral radiographs.