CC BY-NC-ND 4.0 · J Hand Microsurg 2021; 13(02): 089-094
DOI: 10.1055/s-0040-1709213
Original Article

Sensitivity and Specificity of Radiographs in the Diagnosis of Little and/or Ring Carpometacarpal Joint Injuries

Sami Hassan
1   Department of Hand Surgery and Orthopaedic Trauma, Queen’s Medical Centre, Nottingham University Hospitals, Nottingham, United Kingdom
,
Abdul Aziz
1   Department of Hand Surgery and Orthopaedic Trauma, Queen’s Medical Centre, Nottingham University Hospitals, Nottingham, United Kingdom
,
Nicholas D. Downing
1   Department of Hand Surgery and Orthopaedic Trauma, Queen’s Medical Centre, Nottingham University Hospitals, Nottingham, United Kingdom
,
Ryan W. Trickett
2   Department of Trauma and Orthopaedic, Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, United Kingdom
› Institutsangaben

Abstract

Introduction Little and ring finger carpometacarpal joints (CMCJs) injuries are commonly missed due to misinterpretation of radiographs. We aimed to determine the sensitivity and specificity of four different radiographic views.

Materials and Methods Radiographs (posteroanterior [PA], lateral [LAT], pronated oblique [POL], and supinated oblique [SOL] views) showing normal findings or little/ring finger CMCJ injuries were shown to two cohorts of orthopaedic trainees and a cohort of emergency nurse practitioners.

Results The POL view performed best in all three testing scenarios. The SOL view performed least well. The combination of a PA, true LAT, and POL identified 78% of injuries correctly. In no cases did the SOL view correctly identify an injury when the other three views had been interpreted as normal.

Conclusion We recommend a combination of the PA, POL, and LAT views in diagnosing these injuries. Where doubt remains, cross-sectional imaging is essential.



Publikationsverlauf

Artikel online veröffentlicht:
09. April 2020

© 2020. Society of Indian Hand & Microsurgeons. All rights reserved. Thieme Medical and Scientific Publishers Pvt. Ltd., A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 
  • References

  • 1 Hodgson PD, Shewring DJ. The ‘metacarpal cascade lines’; use in the diagnosis of dislocations of the carpometacarpal joints. J Hand Surg Eur Vol 2007; 32 (03) 277-281
  • 2 Yoshida R, Shah MA, Patterson RM. Buford WL Jr, Knighten J, Viegas SF. Anatomy and pathomechanics of ring and small finger carpometacarpal joint injuries. J Hand Surg Am 2003; 28 (06) 1035-1043
  • 3 Chong AK, Chew WY. An isolated ring finger metacarpal shaft fracture?–beware an associated little finger carpometacarpal joint dislocation. J Hand Surg [Br] 2004; 29 (06) 629-631
  • 4 Pullen C, Richardson M, McCullough K, Jarvis R. Injuries to the ulnar carpometacarpal region: are they being underdiagnosed?. Aust N Z J Surg 1995; 65 (04) 257-261
  • 5 Petrie PW, Lamb DW. Fracture-subluxation of base of fifth metacarpal. Hand 1974; 6 (01) 82-86
  • 6 Edwards Jr GS, O’Brien ET, Heckman MM. Retrograde cross-pinning of transverse metacarpal and phalangeal fractures. Hand 1982; 14 (02) 141-148
  • 7 Bain GI, Unni PM, Mehta JA, Eames MH. Arthrodesis of ring finger and little finger metacarpal bases for little finger carpometacarpal joint arthritis. J Hand Surg [Br] 2004; 29 (05) 449-452
  • 8 Gehrmann SV, Kaufmann RA, Grassmann JP. et al. Fracture-dislocations of the carpometacarpal joints of the ring and little finger. J Hand Surg Eur Vol 2015; 40 (01) 84-87
  • 9 Cobb WA, Dingle L, Zarb Adami R, Rodrigues J. Management of fracture-dislocations of the little finger carpometacarpal joint: a systematic review. J Hand Surg Eur Vol 2018; 43 (05) 530-538
  • 10 Bora Jr FW, Didizian NH. The treatment of injuries to the carpometacarpal joint of the little finger. J Bone Joint Surg Am 1974; 56 (07) 1459-1463
  • 11 Day CS, Stern PJ. Fractures of the metacarpals and phalanges. In: Wolfe SW, Htochkiss RN, Perderson WC, Kozin SH, eds. Green’s Textbook of Operative Hand Surgery, 6th ed. Philadelphia, PA: Elsevier 2011: 254-256
  • 12 Dennyson WG, Stother IG. Carpometacarpal dislocation of the little finger. Hand 1976; 8 (02) 161-164
  • 13 Henderson JJ, Arafa MA. Carpometacarpal dislocation. An easily missed diagnosis. J Bone Joint Surg Br 1987; 69 (02) 212-214
  • 14 Storm JO. Traumatic dislocation of the fourth and fifth carpo-metacarpal joints: a case report. J Hand Surg [Br] 1988; 13 (02) 210-211
  • 15 Talbot CL, Ring J, Holt EM. Litigation relating to conditions affecting the shoulder and elbow: an analysis of claims against the National Health Service. Bone Joint J 2014; 96-B (05) 574-579
  • 16 Khan IH, Giddins G. Analysis of NHSLA claims in hand and wrist surgery. J Hand Surg Eur Vol 2010; 35 (01) 61-64
  • 17 NHSLA. The NHS Litigation Authority Factsheet 2: Financial Information, 2012. Available at: https://www.futurefocusedfinance.nhs.uk/sites/default/files/media-posts/139970_NHS%20LA%20Factsheet%202%20-%20financial%20information%202012-13.pdf Accessed December 14, 2018