Additional Diagnostic Value of Four-View Radiography in Acute Finger Trauma: A Retrospective Single-Center Diagnostic...

Background/Objectives: Acute finger trauma is frequently encountered in outpatient orthopedic practice, and accurate initial radiographic diagnosis is essential for treatment planning. Standard two-view radiography, consisting of posteroanterior and lateral views, may miss projection-dependent phalangeal fractures. This study evaluated the additional diagnostic value of oblique and reverse oblique radiographs in acute finger trauma. Methods: This retrospective single-center diagnostic cohort study included patients with acute finger trauma who underwent four-view radiography at the initial visit. Images were reviewed in a two-step manner: first using standard two-view assessment and then after adding oblique and reverse oblique views. The primary outcome was the incremental diagnostic yield of additional views among final fracture cases. Results: Among 282 included episodes, 157 fractures and 125 non-fracture injuries were identified. Of the 157 fractures, 136 were detected on standard two-view assessment, whereas 21 were detected only after adding oblique and reverse oblique views, corresponding to an incremental diagnostic yield of 13.4% (95% confidence interval, 8.9-19.6%). Approximately one quarter of fractures were visible in only a single projection. Four-view-only fractures were more frequently located in the central digits. Residual range-of-motion limitation differed significantly among groups and was more frequent in both fracture groups than in the non-fracture group. Conclusions: Additional oblique and reverse oblique radiographs improved fracture detection in acute finger trauma. Four-view radiography may reduce projection-dependent underdetection of phalangeal fractures, particularly in injuries involving the central digits.