Multidetector CT of carpal injuries: anatomy, fractures, and fracture-dislocations

Fractures and dislocations of the carpal bones are more common in young active patients. These injuries can lead to pain, dysfunction, and loss of productivity. Conventional radiography remains the primary imaging modality for evaluation of suspected carpal fractures and dislocations. However, multidetector computed tomography (CT) is playing an increasingly important role, especially in the following situations: (a) when results from initial radiographs are negative in patients with suspected carpal fractures, (b) when initial radiographic findings are indeterminate, and (c) when knowledge of the extent of carpal fractures or dislocations is required before surgical treatment. The advantages of multidetector CT include quick and accurate diagnosis with availability in most emergency centers. Multidetector CT can easily display the extent of carpal fractures and dislocations, often depicting fractures that are occult at radiography. In addition, with multiplanar (two-dimensional) and volumetric (three-dimensional) reformation, pathologic conditions and anatomic relationships are better perceived. This information can be easily conveyed to orthopedic and trauma surgeons and can be crucial for surgical treatment and planning.