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Radiographic views for hand fractures - call for three-view national UK guidelines - a quality improvement study
Clea Southall1, Thessa R Friebel, Sonya Gardiner
1Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK.
International Journal of Surgery (London, England)
|June 8, 2023
Summary
A three-view radiographic examination is vital for diagnosing hand fractures, yet many patients lack this standard imaging. National guidance is needed to ensure consistent, accurate hand fracture assessment and reduce misdiagnosis.
Area of Science:
- Radiology
- Orthopedics
- Trauma Surgery
Background:
- Accurate hand fracture assessment relies on a three-view radiographic examination (antero-posterior, oblique, lateral).
- Multiple studies confirm the diagnostic superiority of three views over two for hand injuries.
- The American College of Radiology recommends three views, but UK guidance is lacking.
Purpose of the Study:
- To evaluate the adherence to three-view radiographic examinations for hand fractures in a UK tertiary hand trauma unit.
- To identify discrepancies in radiographic views for metacarpal and phalangeal fractures.
- To advocate for national guidance on standardized hand fracture imaging protocols.
Main Methods:
- Retrospective review of 235 patients with confirmed hand fractures at a tertiary hand trauma unit.
- Analysis of radiographic views (antero-posterior, oblique, lateral) obtained for each fracture.
- Review of radiology protocols from six local hospitals.
Main Results:
- Only 45% of patients with hand fractures had a three-view radiographic examination.
- Three views were available for 57% of metacarpal fractures (lateral view most common omission).
- Only 30% of phalangeal fractures had three views (oblique view most common omission).
- Local hospital radiology protocols were inconsistent regarding three-view recommendations for phalangeal injuries.
Conclusions:
- Significant underutilization of three-view radiographic examinations for hand fractures exists in the UK.
- Inconsistent local protocols contribute to variability in hand fracture imaging.
- National guidance is required to standardize hand fracture assessment and improve diagnostic accuracy.
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