The clinical efficacy of triple-injection wrist arthrography

Triple-injection wrist arthrography has been demonstrated to increase the likelihood that all the ligamentous perforations in an injured wrist will be diagnosed. However, compared with imaging after single injection of contrast material into the radiocarpal joint, triple-injection arthrography not only increases patient expense but also significantly increases the time required of both patients and arthrographers to obtain the diagnosis. With the goal of decreasing the number of triple injections, the author reviewed 50 consecutive triple-injection wrist arthrograms. Using a technique based on high-volume injection of contrast material to achieve complete distention of the joint, the author achieved a false-negative rate for demonstration of complete perforations with radiocarpal injection alone of only 2% (10% if partial perforations were included). In none of these cases was patient treatment altered by the additional information provided by the second and third injections. This false-negative rate is significantly lower than that reported previously and raises the question of whether there are circumstances in which the easier and less time-consuming single radiocarpal injection might be appropriate.