Fractures of the wrist and hand are the reason for 1.5% of all emergency department visits(1).Less than 20% of patients with a clinically suspected scaphoid fracture have a true fracture(2). In the acute setting 5-20% of scaphoid fractures can be missed on initial radiographs(3). Plain radiography may be limited by superposition of anatomical structures, suboptimal positioning and technique, and suboptimal patient cooperation in emergency settings(4). Failure to immobilise a wrist with a fracture can lead to complications such as non-union, avascular necrosis, development of carpal...

Patients and inclusion/ exclusion criteria In July 2017 the imaging protocol in our hospital was changed for patients with acute wrist trauma to include a CBCT of the wrist in patients who had negative radiographs at initial evaluation and persistent clinical concern for a radiographically occult radiocarpal fracture. This scan was performed simultaneously with radiographs at time of follow up review in the orthopaedic clinic, usually 7-14 days after the initial trauma. If CBCT showed a fracture which corresponded to a point of clinical tenderness,...

Demographics Between July 2017 and February 2018, CBCTs were performed on 269 patients. 103 were excluded as they were for evaluation of known fractures, post-operative imaging or chronic pain assessment. 166 scans were performed patients with suspected radiocarpal fractures after trauma despite no fracture visible on initial radiographs. 49 were excluded as CBCT was performed over 2 weeks after wrist trauma. 117 were performed within the predetermined time limit of 2 weeks for acute fracture. The median number of days from initial trauma to CBCT...

We found that CBCT is highly sensitive for acute radiocarpal fractures in patients with clinical suspicion for fracture despite negative radiographs. CBCT provides more accuracy and diagnostic information than radiographs at a low radiation dose. We believe it has a place in the diagnostic work-up in extremity trauma. It could replace MDCT and restrict the need for follow up MRI to only the most suspicious cases. If appropriate resources for interpretation were in place, CBCT could potentially replace radiographs as the first line imaging investigation...

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