gms | German Medical Science

Objectives/Interrogation: The aim of this study is to characterize the injury pattern, review correlation between plain radiological and MRI findings, and the patient care pathway experienced by under 16's presenting with closed trauma of the wrist.

Methods: A prospective audit of consecutive cases of blunt wrist trauma referred to our tertiary hand and upper limb service was conducted between August 2017 and August 2018.

Results and Conclusions: 72 cases were included. The mean age is 12 years (range 7-16). 72% of patients presented within 48 hours of injury to the emergency department (ED), and 68% were referred to our hand service on the same day. 44% of cases were secondary to fall on an outstretched hand. Management from ED consisted of casting(43%), splinting(35%), volar slab(10%), sling elevation(1%) and none(11%).

The mean period between referral from ED to patients' initial review at the hand service was 4.5 days. 78% of patients described pain, 33% swelling and 22% reduced range of motion of the affected wrist. Plain film radiology revealed fractures in 17% of cases, no fracture in 54% and suspected fractures in 29%.

At the second review, 40% of patients described pain, 4% swelling and 7% reduced range of motion. On MRI, 18% of cases showed no injury, 6% other pathologies and 18% were awaiting scans. All fractures identified on plain film was confirmed on MRI, with an additional 31 carpal fractures seen (10 with suspicious features & 21 with no features of fracture on X-ray). The most common carpal fracture was scaphoid fractures. Other injuries identified on MRI included other non-scaphoid carpal fractures (5 trapezium, 4 each of capitate and lunate, 3 hamate, 2 triquetrum, 1 each of pisiform and trapezoid), metacarpal bases and distal radius fractures, TFCC injury and ganglion.

Patients under the age of 10 were the minority, consisting of 5 cases (7%). All were female, aged 7-9, and underwent MRI. Imaging revealed 2 scaphoid fractures, 1 triquetral fracture and no injury in 2 cases.

47 patients completed treatment, with a mean of 3.4 clinical visits (range 1-7), and mean 5.8 weeks of follow-up (range 1-14). 1 case required arthroscopy.

Paediatric carpal injuries are a relatively uncommon entity, and early detailed imaging in symptomatic wrists that fail to respond to immobilisation may allow earlier diagnosis and timely instigation of treatment. Refinement of the local carpal injury management algorithm based on the results of the prospective audit will be discussed.