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Virtual reality (VR) simulation is a technology that empowers students and radiographers to practice radiography in a virtual environment that resembles real-life clinical scenarios. The purpose of this randomised study was to examine the relationship between clinical specialty and the ability to assess and obtain a lateral wrist radiograph using a VR simulator. Radiographers and radiography students were recruited from the EFRS Research Hub at the 2024 European Congress of Radiology. After completing a background questionnaire, participants entered a VR simulator where they assessed lateral wrist radiographs and, if necessary, attempted a retake. Fisher's exact test was used to evaluate the relationship between specialties and participants' ability to assess positioning and perform retakes. Rank-biserial correlation estimated the relationship between participants' ability to reposition the VR patient and their VR experience and self-perceived confidence in wrist radiograph positioning. The cohort included 173 participants from 14 specialties across 21 countries. There was a borderline significant trend between clinical specialty and correct positioning assessment (p = 0.052) and between self-perceived confidence in acquiring wrist radiographs and repositioning for a retake (p = 0.052). Neither clinical specialty (p = 0.480) nor previous VR experience (p = 0.409) correlated with ability to reposition for a retake. While results indicated a potential correlation between participants' ability to position a VR patient and both clinical specialty and confidence in wrist radiography, these trends were not statistically significant. Nevertheless, the findings suggest that VR holds promise for radiography training, though further research is necessary to explore the factors that influence performance and learning. The incorporation of VR technology into standard radiography training programs could potentially improve patient outcomes by ensuring that radiography students are more skilled at acquiring quality radiographs prior to their first clinical practice. It should be noted though, that knowledge on positioning criteria and anatomy is an advantage when practicing correct positioning in a VR simulator. [ABSTRACT FROM AUTHOR]

Open Reduction and Internal Fixation (ORIF) with volar locking plates are commonly used to manage distal radial fractures. The anatomical tilt lateral (ATL) wrist X-ray is often required for evaluation of intra-articular screw penetration due to the screw position. This study aims to evaluate the correlation between the tube angulation given by performing radiographers for the ATL projection and the post-examination measurement of radial inclination (RI) on the Posterior Anterior (PA) wrist image. A retrospective review was performed for 36 patients. A standardised method developed by Kreder et al. (1996) was used to measure the RI on the PA wrist image. All ATL images sent into Picture Archiving and Communications System (PACS) have the tube angulation applied annotated on the image. Pearson's correlation was used to analyse the co-relationship between the RI and the tube angle applied for ATL projection. The average angle of RI measured by the four observers was 19. Normality of 0.385 was established. A positive correlation (p = 0.792) between the RI and the tube angle applied for ATL was found. Our study found a strong positive correlation between the tube angulation applied by performing radiographers for the ATL projection and the post-examination RI measured on the PA wrist image by the independent reviewers. This suggests that radiographers can use the measured RI to apply the tube angulation when performing the ATL wrist X-ray, instead of estimating the tube angulation to be applied. Using the measured RI to apply the tube angulation when performing the ATL wrist X-ray will ensure a more reliable and reproducible way that could reduce the number of repeated images and, thus, unnecessary radiation dose to patients. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Medical Imaging & Radiation Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Injuries to the triangular fibrocartilage complex (TFCC) and distal radioulnar joint (DRUJ) require careful consideration and management to ensure an optimal outcome. These complex injuries can be effectively managed by having a fundamental understanding of the anatomy of the structures involved in addition to an appreciation of the biomechanical modes of failure in the context of wrist trauma. The principles of managing these injuries are addressed in this article by focusing on the relevant anatomy and highlighting the key features of clinical and radiological assessment. An outline of the surgical treatment options is included to help the clinician select the most appropriate treatment ranging from soft tissue repair to salvage measures. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Medical Imaging & Radiation Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Ultrasound (US) seems a useful tool for diagnosis of calcium pyrophosphate (CPP) deposition (CPPD). We aimed to compare the performance of US and conventional radiography of the wrist for diagnosis of CPPD.Methods: Patients with CPP crystals identified in synovial fluid (SF) (knee, hip, shoulder, ankle or wrist) were consecutively included and compared to patients without CPP crystals in synovial fluid considered as controls. As recommended, we used the term chondrocalcinosis (CC) to assess imaging features suggesting CPPD. In all patients, US and radiographic assessment of CC of the wrists was performed by two distinct operators blinded each other (one operator by imaging modality). The two operators were blinded to clinical data, SF analysis and US or radiography findings.Results: We included 32 CPPD patients and 26 controls. Among CPPD patients, US revealed CC in 30 (93.7%) and radiography in 17 (53.1%) (P<0.001). The sensitivity and specificity of US for the diagnosis of CPPD were 94% and 85%, respectively; the positive likelihood ratio (LR+) was 6.1. The sensitivity and specificity of radiography were 53.1% and 100%, respectively. At joints level independently of SF analysis, US revealed CC in 35 joints without radiographic CC whereas X-rays showed CC in 3 joints without US CC. The κ coefficient between US and radiography for CC was moderate: 0.33 (0.171-0.408).Conclusion: Our study suggests that wrist US should be considered as a relevant tool for the diagnosis of CPPD, with higher sensitivity than radiography for detecting CPP deposits. [ABSTRACT FROM AUTHOR]

Study Design Descriptive Epidemiological Study. Introduction Ligament tears between carpal bones are easily missed on initial presentation, but can have potentially debilitating effects on the patient if they progress to an instability. They are usually the result of a fall onto an outstretched hand with the wrist in hyperextension. Current incidence of carpal instability after these falls is unknown. Purpose of the Study Using established clinical and radiological measures, we sought to establish the cumulative incidence of carpal instability in people who have fallen onto an outstretched hand in the second year after injury. We also sought to describe its relationship with functional impairment. Methods We used emergency department records of an inner-urban tertiary hospital to contact all patients who presented with wrist pain following fall onto outstretched hand who were between one and two years after injury. Carpal instability was defined by blinded radiological evaluations and provocative clinical tests, including Scaphoid Shift (Watson’s) test, Ballottement, and mid-carpal shift test. Wrist-related pain and disability was measured using the Patient-Rated Wrist and Hand Evaluation. Results Of the 279 potentially eligible cases, only 146 were contactable, and fifty (28 male, 22 female; mean age of 48 years) attended for assessment. We found a cumulative incidence of 44% of carpal instability within the second year after injury. Of these, 12 (24%) cases had scapho-lunate instability, 12 (24%) had luno-triquetral instability and 7 (14%) had mid-carpal instability. There were no significant correlations between clinically confirmed carpal instability and pain, function, or work participation. Discussion and Conclusion This study found a higher than anticipated cumulative incidence of carpal instability in the second year after injury, which may reflect volunteer bias. Patients should be advised to monitor symptoms in the year after injury and seek a review if symptoms of pain, clicking or clunking arise. Level of Evidence II [ABSTRACT FROM AUTHOR]

Segmentation of the carpal bones from 3D imaging modalities, such as magnetic resonance imaging (MRI), is commonly performed for in vivo analysis of wrist morphology, kinematics, and biomechanics. This crucial task is typically carried out manually and is labor intensive, time consuming, subject to high inter- and intra-observer variability, and may result in topologically incorrect surfaces. We present a method, WRist Image Segmentation Toolkit (WRIST), for 3D semi-automated, rapid segmentation of the carpal bones of the wrist from MRI. In our method, the boundary of the bones were iteratively found using prior known anatomical constraints and a shape-detection level set. The parameters of the method were optimized using a training dataset of 48 manually segmented carpal bones and evaluated on 112 carpal bones which included both healthy participants without known wrist conditions and participants with thumb basilar osteoarthritis (OA). Manual segmentation by two expert human observers was considered as a reference. On the healthy subject dataset we obtained a Dice overlap of 93.0 ± 3.8, Jaccard Index of 87.3 ± 6.2, and a Hausdorff distance of 2.7 ± 3.4 mm, while on the OA dataset we obtained a Dice overlap of 90.7 ± 8.6, Jaccard Index of 83.0 ± 10.6, and a Hausdorff distance of 4.0 ± 4.4 mm. The short computational time of 20.8 s per bone (or 5.1 s per bone in the parallelized version) and the high agreement with the expert observers gives WRIST the potential to be utilized in musculoskeletal research. [ABSTRACT FROM AUTHOR]

Background Dental and skeletal maturation have proved to be reliable evidence for estimating age of children and prior studies and internationally accredited guidelines recommend to evaluate both evidence in the same subject to reduce error in age prediction. Nevertheless the ethical and legal justification of procedures that imply a double exposition of children stands as a relevant issue. This study aims to evaluate the accuracy of age estimation provided by a combination of skeletal and dental methods applied in the same sample of children. Materials and methods The sample consisted of 274 orthopantomographies and left hand-wrist X-rays of Italian children, (aged between 6 and 17 years) taken on the same day. Greulich and Pyle’s (GP), Tanner-Whitehouse’s version 3 (TW3) and Willems’ (W) and the Demirjian’s (D) methods were respectively applied for estimating skeletal and dental age. A combination of skeletal and dental age estimates through Linear Discriminant Analysis (LDA) is proposed to obtain a classifier respect to an age threshold. Results The combination of D and TW3 obtained an improvement of accuracy in classifying female subjects respect to the 12 years threshold respect to the original methods (from about 77% using either original methods to 83.3% combining TW3 + D) as well as a consistent reduction of false positives rate (from 17% to 21% for original methods to 5.6% with TW3 + D). For males the LDA classifier (based on TW3 and W) enable a small improvement in accuracy, whilst the decreasing of false positives was as noticeable as for females (from 17.6 to 14.1% for original methods to 6.2% combining TW3 + W). Conclusions Although the study is influenced by the limited size and the uneven age distribution of the sample, the present findings support the conclusion that age assessment procedures based on both dental and skeletal age estimation can improve the accuracy and reduce the occurrence of false positives. [ABSTRACT FROM AUTHOR]

PA and lateral wrist radiographs ar standard views performed post operatively. However, due to anatomic tilt and inclination of radius articular surface, an ATL wrist radiograph is requested to evaluate for possible intra-articular screw penetration. This 22-degree angulation does not represent the exact radial inclination measurement of individual patients, resulting in suboptimal visualization of the radiocarpal joint space. This could precede either repeats of radiographs, misinterpretation of intra-articular screw penetration or further evaluation via CT imaging. This study aims to determine if there is a correlation between radial inclination measured on PA wrist radiographs and the tube angulation applied for the ATL wrist radiograph. Radiographers will perform PA, lateral, and ATL radiographs on patients aged between 21 to 75 years old. The degree of angulation given for the ATL view, accession number, gender, and age are then recorded on a data collection sheet. Radiographs retrieved from PACS will be anonymized and coded with number code assigned to the data set of each respective patient, and then copied into a DVD. Thereafter, measurements of the radial inclination will be done by the Co-Is individually. An inter-rater reliability test will be performed to ensure reliability in the measurements done by Co-Is. Statistical correlation will be performed between the radial inclination on the PA wrist radiograph and angulation given on the ATL. Measurements taken for each wrist, by 4 radiographers, were added together and averaged out. SPSS was used, showing a strong positive Pearson's correlation coefficient of 0.792 between the annotated angle and the average radial inclination measured by the participants. There is excellent intraclass correlation of 0.977 between the data measured by the participants. There is a positive correlation between the radial inclination measured on the PA radiograph and tube angulation given for ATL wrist radiograph. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the value of the muscle-to-bone ratio (MBR), which is the ratio between the maximum pronator quadratus thickness (mPQT) and the distal radial thickness (DRT) at the same level, in comparison with mPQT in the diagnosis of undisplaced fractures in distal forearm (FDF) on radiographs.Material and Methods: This study was conducted with 210 wrists of 210 volunteers (79 male, 131 female) and 106 wrists of 106 patients with acute undisplaced FDF (53 male, 53 female). The mPQT was measured on lateral radiographs, and the MBR was calculated for each wrist.Results: The mean mPQT (7.37 ± 1.99 mm) and MBR (0.55 ± 0.15) in the fracture group were significantly larger than those (4.70 ± 1.42 mm and 0.31 ± 0.09) in the control group respectively (all P<0.05). Sexual differences of mPQT were found in both control and fracture groups (all P<0.05). There were no gender differences of MBR in either control or fracture group (all P>0.05). ROC analysis revealed that the discriminating efficacy of MBR was significantly superior to that of mPQT (P<0.01). The most optimal diagnostic discrimination was obtained by a MBR cut-off value of 0.4.Conclusions: The MBR can be used as a new index for the diagnosis of undisplaced FDF, as well as a complementary means to detect occult fractures. If the MBR is larger than 0.4 in a patient with suspected or occult FDF, a further MRI examination will be justifiably needed. [ABSTRACT FROM AUTHOR]

Aim: To characterise the normal motion pattern of the pisotriquetral (PT) joint during wrist extension and flexion, as well as observer performance of measurements using four-dimensional (4D)-computed tomography (CT) acquisitions and double-oblique multiplanar reconstruction (MPR) technique in asymptomatic contralateral joints of patients with unilateral wrist pain.Materials and Methods: In this Health Insurance Portability and Accountability Act (HIPAA)-compliant institutional review board-approved study, 4D-CT was performed on the asymptomatic contralateral wrists of 10 patients (mean age: 46 years; M/F: 6/4) for comparison to the symptomatic side. Two independent observers defined the "oblique-sagittal" plane for PT joint measurements. Measurements were obtained for the anteroposterior (AP) interval and craniocaudal (CC) excursion during the extension-flexion arc of wrist motion.Results: The median (interquartile range) of the AP interval was 0.65 mm (0.55-1 mm) in extension, 1.1 mm (0.8-1.82 mm) in the neutral position, and 4.65 mm (2.07-5.87 mm) in flexion. Likewise, the median of the CC excursions in asymptomatic wrists were 0 mm in extension, 0.27 mm (0-0.37 mm) in the neutral position, and 0.28 mm (0.18-0.31 mm) in flexion. The AP interval measurements obtained at wrist flexion were larger than measurements obtained at wrist extension. There was a strong consistency in AP interval difference measurements between the two observers (ICC=0.80; p<0.01); however, CC excursion difference measurements did not reach the significance threshold between the two observers (ICC=0.40; p=0.11).Conclusion: PT joint kinematics in asymptomatic wrists demonstrates an increase in AP interval and CC excursion during wrist flexion. MPR techniques provide good interobserver agreements for AP interval measurements. The reported intervals for asymptomatic joints can be used as a reference for asymptomatic wrists. [ABSTRACT FROM AUTHOR]

The article offers information on the advantages of a novel hinged orthosis which allows the selective midcarpal mobilization along the plane of the dart throwing motion and mentions the applications of the orthotic device. It mentions that orthotic device provide assistance to rehabilitation protocols which limits radiocarpal joint mobility and scapho-lunate ligament overload and also speed up the wrist functional recovery after ligamentous injuries.

Wrist injuries are common and ongoing wrist pain is a cause of functional loss in the general population especially affecting the younger population. It is a complex joint comprised of the distal radio-ulnar joint (DRUJ), the radio-carpal joint (RCJ), the intercarpal joints and the carpo-metacarpal joint (CMCJ). The primary radiological investigation of the wrist is plain film radiography. Advanced imaging techniques play an important role in evaluating the complex anatomy of bone and soft tissues of the wrist. This is a result of the bony arrangement, multiple ligamentous structures and triangular fibrocartilage complex (TFCC), which provide much needed support to the wrist. As such, second line investigations including ultrasound (USS), computerized tomography (CT) and magnetic resonance imaging (MR) are increasingly used to diagnose wrist pathologies. These modalities allow a more focused assessment of the bony and soft tissue structures in this region. This in turn can enable faster diagnosis of a patient's condition, leading to a more efficient management plan and a quicker return to functional activity. We hereby, present an educational review from an imaging perspective that demonstrates a range of pathologies that would otherwise be missed or unapparent if advanced imaging is not utilised. [ABSTRACT FROM AUTHOR]

Abstract: The objective of this study was to develop and validate a computer-based module for wrist arthroscopy to which a group of experts could consent. The need for such a module was assessed with members of the European Wrist Arthroscopy Society (EWAS). The computer-based module was developed through several rounds of consulting experts on the content. The module's learning enhancement was tested in a randomized controlled trial with 28 medical students who were assigned to the computer-based module group or lecture group. The design process led to a useful tool, which is supported by a panel of experts. Although the computer based module did not enhance learning, the participants did find the module more pleasant to use. Developing learning tools such as this computer-based module can improve the teaching of wrist arthroscopy skills. [Copyright &y& Elsevier]

New technology has the potential to greatly impact the medical field because it may lead to a greater quality of life, decreased pain, or increased function for our patients. This manuscript will discuss the introduction of one such advance in hand surgery and hand therapy. Utilizing the Mini-Tightrope™ (Arthrex, Naples, FL) for suspension of the thumb metacarpal following trapeziectomy is a new technique for treating thumb carpometacarpal (CMC) arthritis. This technique is described as an example of the advantages of considering new techniques and technologies when treating established problems. This article discusses the responsibility of health professionals in considering the adoption of new technologies over current ones in the context of describing a new type of CMC suspensionplasty procedure. Further, a description of the surgical technique, the hand therapy postoperatively, and a case study to demonstrate some of the features of the Tightrope suspensionplasty procedure is presented. In the author's experience, the reduced healing time, reduced weeks of immobility, and fewer therapy visits following the procedure suggest that the Tightrope procedure should be considered as an option for patients needing thumb CMC arthroplasty. [ABSTRACT FROM AUTHOR]

Surgical procedures for the treatment of rheumatoid arthritis are aimed at restoring function and decreasing pain. Over the past four decades multiple procedures have been described in the management of early and late disease. This article will review the most common forms of surgery used in the treatment of rheumatoid arthritis. [ABSTRACT FROM AUTHOR]

Introduction: Favorable clinical outcomes have been reported with the Artelon CMC Spacer, however, several studies have documented complications with the device. Purpose of the study: The purpose of this study is to review a single surgeon's experience with the Artelon CMC Spacer for the treatment of basal joint arthritis of the thumb. Methods: Five thumbs in 6 patients with symptomatic osteoarthritis of the thumb carpometacarpal (CMC) joint were treated with the Artelon CMC Spacer. The mean age of the patients was 60.8 years old. Patients were followed for a mean of 39.3 months (6-63) post-operatively. Results: Complications occurred in 4 of the 6 thumbs and half of the thumbs required at least one secondary operative procedure. A documented foreign-body reaction was present in 2 of the 6 thumbs. Discussion: The Artelon CMC Spacer is an interposition material that acts as a biologic spacer for arthritic joints while maintaining mechanical strength. Conclusions: Due to an unacceptably high complication rate, we no longer use the Artelon CMC Spacer for the management of basal joint arthritis of the thumb. [ABSTRACT FROM AUTHOR]

There are many surgical procedures that provide pain relief and improve function for trapeziometacarpal (TM) arthritis. The aim of this article is to review the history of surgical treatment of thumb basal joint arthritis and to discuss some of the recent advances based on evolving technology. Our preferred treatment is described, and explanation provided for why we have avoided the temptation to change to the "latest and greatest" treatment for this condition. [ABSTRACT FROM AUTHOR]

Background: There is a conflict in the treatment of distal radius fractures in elderly patients, because fracture reduction does not appear to be as strongly associated with functional outcomes as in younger patients. The purpose of this study was to evaluate radiographic findings of acceptable reduction without leading to wrist dysfunction and poor outcomes. Methods: Fifty-two active and healthy elderly patients with conservatively managed distal radius fractures were included in the study. They consisted of 7 men and 45 women, all 60 years or older. Radiographic assessment included volar tilt, radial inclination and ulnar variance, and outcome evaluation included the Mayo wrist score and DASH score. As a control group, the preoperative radiographic and clinical outcomes were examined as well for 19 patients older than 60 with malunion, for whom corrective osteotomy was performed because of wrist dysfunction. The radiographic parameters and clinical outcomes were compared between the two groups in a statistical manner. Correlation coefficients of the radiographic parameters with Mayo wrist score and DASH score were analyzed by multiple regression. Results: Volar tilt (mean −1.2°) and ulnar variance (mean 2.5 mm), as well as Mayo wrist score (mean 80.0 points) and DASH score (mean 8.6 points) in the objective group were significantly superior to those in the control group when comparing radiographic parameters and clinical outcomes. There was no significant difference between the two groups in regard to RI (mean 14.9°). Multiple regression analysis revealed that volar tilt and ulnar variance were significantly correlated with the clinical outcomes in the objective. Conclusion: The parameters of volar tilt and ulnar variance had a significant correlation with clinical outcomes. Clinical outcomes significantly worsened when those parameters exceeded a tolerable range. In elderly patients, it is important to determine an appropriate therapeutic modality for a distal radius fracture when considering the acceptable parameters for alignment. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Dynamic Computed Tomography (CT) promises insights into the pathophysiology of carpal instability by recording images of the carpus while it is in motion. The purpose of this study was to investigate the effect of motion velocity on image quality for dynamic carpal imaging applications using a clinical dual-source CT (DSCT) scanner. Methods: A phantom with targets in the axial, coronal and sagittal planes was attached to a motion simulator and imaged using a 64-slice DSCT scanner. Data was acquired when the phantom was stationary and during periodic linear motion. Spatial resolution, motion artifacts and banding artifacts were assessed. Results: Mean spatial resolution was 0.82mm at 36mm/s and 0.79mm at 18mm/s. Banding artifacts were mild at 36mm/s and minimal at 18mm/s. Motion artifacts were minimal at motion velocity of up to 36mm/s in both the coronal and sagittal planes. Axial plane motion artifacts were moderate at 36mm/s and mild at 18mm/s. Discussion: Sub-millimeter resolution is achievable with commercially available DSCT scanners with mild to moderate amounts of motion artifacts at velocities of 18mm/s and 36mm/s respectively. [Copyright &y& Elsevier]

Purpose: To evaluate the long-term results of a prospective, longitudinal case series of untreated, traumatic triangular fibrocartilage complex (TFCC) tears found in displaced distal radial fractures. Methods: Between 1995 and 1997, 51 patients (24 men, 27 women; age, 20–57 y) with a displaced distal radius fracture had wrist arthroscopy to identify associated injuries. Forty-three patients had complete or partial tears of the TFCC, which were not treated. All patients were contacted in 2010, 13–15 years after the injury. One patient had had a TFCC reattachment due to painful distal radioulnar joint instability and was excluded. Thirty-eight patients returned for a radiographic and clinical follow-up that recorded strength, distal radioulnar joint laxity, range of motion, pain scale score, and subjective and objective outcome scores. Results: After 13–15 years, 17/38 patients were lax in the distal radioulnar joint. The mean grip strength was worse in the patients with a lax distal radioulnar joint (83%, SD 15 of the contralateral side vs 103%, SD 33). The median Gartland and Werley score was 5 (good; range, 0–15) in the lax group compared to 1 (excellent; range, 0–9) in the non-lax group, and the median Disabilities of the Arm, Shoulder, and Hand scores were 14 (range, 0–59) and 5 (range, 0–70) respectively. Conclusions: In this 13–15 year, prospective, longitudinal outcome study of the natural course of TFCC tears associated with distal radius fracture, only 1 patient had been operated on for painful instability since the injury. The subjective and objective results did not provide evidence that a TFCC injury would influence the long-term outcome. However, trends were found and, by speculation, the low number of patients in the series and the risk for a type II error could be the cause of absent statistically significance. Larger, preferably prospective, randomized studies are needed to find out whether a more aggressive treatment is beneficial. Type of study/level of evidence: Diagnostic I. [Copyright &y& Elsevier]

Purpose: Scapholunate dissociation (SLD) is thought to be a common cause of both acute and chronic wrist pain. Classically, this condition is attributed to a traumatic event and is thought to inevitably lead to the development of degenerative arthritis. Bilateral findings should thus be infrequent. The purpose of the present study was to determine the incidence of bilateral radiographic SLD and associated arthritic changes. Methods: Demographic, radiographic, and clinical data were obtained from 124 patients with abnormal x-ray findings in at least 1 wrist. Radiographs reviewed included posteroanterior, lateral, and Moneim views of both symptomatic and asymptomatic wrists. Pathology was defined as a scapholunate gap ≥ 5 mm and/or a scapholunate angle ≥ 60°. Arthritic changes were assessed. Results: A majority of the 124 patients (51%) were unable to recall any specific injury to their wrist. On the symptomatic side, 101 (81%) patients had a pathologic measurement for their scapholunate gap, and 109 (88%) had an abnormal angle measurement. On the asymptomatic side, 64 (52%) of the gap measurements and 87 (70%) of the angle measurements were pathologic. Ninety-nine patients (80%) had abnormal radiographic findings bilaterally for at least 1 variable on each side. Only 13 patients (11%) had a clinical instability pattern typical of SLD. Half the patients had radiographic degenerative changes at presentation. Conclusions: Bilateral radiographic SLD is much more common than previously assumed, is often asymptomatic, and does not inevitably lead to degenerative arthritis. These findings should call into question the assumption of a uniquely traumatic etiology. Further, most patients presented with pathologies unrelated to the scapholunate articulation. Surgical intervention chosen on the basis of radiologic findings, in the absence of clinical instability, might not be the best course of action, unless criteria are established to determine which patients eventually develop arthritic changes or become symptomatic. Type of study/level of evidence: Therapeutic III. [Copyright &y& Elsevier]

Purpose: Several techniques used to measure ulnar variance on a posteroanterior wrist radiograph have been described. It remains unclear whether they accurately represent the true ulnar variance of the patient. The purpose of this study was to correlate ulnar variance measurements on plain radiographs, computed tomography (CT), magnetic resonance imaging (MRI), and anatomic dissection. Methods: Posteroanterior (PA) radiographs, coronal and sagittal CT scans, and coronal MRI scans were obtained on 8 fresh-frozen cadaver wrists. The ulnar variance was measured by 5 reviewers. The specimens were then dissected, exposing the wrist joint. The ulnar variance was measured directly on each specimen using digital calipers. The inter-rater reliability was calculated for each imaging modality. The bias for each imaging modality was calculated using the digital caliper measurements as the true ulnar variance. Results: Intraclass correlation coefficients demonstrated excellent inter-rater reliability for each imaging modality. The average bias from the true variance was the following: PA radiograph, 0.77 mm; coronal CT, 0.96 mm; sagittal CT, 0.96 mm; MRI with articular cartilage, 0.73 mm; MRI excluding cartilage, 0.49 mm. The variance measured on all imaging modalities tended to underestimate the magnitude of the true variance. Conclusions: Ulnar variance measured on coronal MRI best reflected the true ulnar variance as measured directly using calipers. The CT scans demonstrated the greatest deviation from the true variance. However, differences were small and might not be clinically meaningful. All imaging modalities demonstrated excellent inter-rater reliability, with MRI being highest. All imaging modalities tended to underestimate the magnitude of the true variance. Clinical relevance: The imaged underestimation of true ulnar variance should be taken into account when performing surgical procedures that alter the relative lengths of the radius and ulna. [ABSTRACT FROM AUTHOR]

Abstract: Age estimation of living individuals often represents a forensic challenge with important legal and social implications. In an effort to better understand the accuracy of the methods of Greulich and Pyle (GP), Tanner–Whitehouse (TW) and Fels, a systematic review and a meta-analysis of articles published from 1956 to 20 December 2009 in the Medline and Trip databases were conducted. We only selected articles on healthy people. The meta-analysis showed that GP is not as accurate a method as TW2 or TW3 for both Caucasian people and Mongoloids, even if it is the one most often used. However, due to the very wide age estimation range, in line with what has already been established by several authors, our systematic review and meta-analysis confirmed that age estimation in living individuals cannot be considered accurate when only X-ray methods on the left hand-wrist are used, but exhaustive combinations of various procedures (i.e. physical examination, dental and skeletal methods) must also be used, as proposed and already applied by the International Study Group on Forensic Age Estimation. [Copyright &y& Elsevier]

Abstract: The primary objective of this study was to evaluate, if in multidetector computed tomography (MDCT) of the wrist a good image quality can be maintained while radiation dose is substantially reduced. In a second approach one solely parameter change that allows for the best trade-off between dose reduction and image quality should be identified. Twenty wrist specimens were examined with a 16-slice MDCT in different parameter combinations: 120 and 100kV, 100, 70 and 40electronicmAs, pitch factor 0.9 and 1.5. Images were reconstructed in four standard planes (slice thickness 1.0mm, increment 0.5mm, hard kernel) resulting into a total number of 960 images. Two observers evaluated image quality in a blinded and randomized consensus scheme. Detail quality of corticalis, spongiosa, articular surface and soft tissues was graded according to a four-point scale (1=excellent, 2=good, 3=sufficient, and 4=poor). The scan protocol with the best trade-off between radiation exposure and image quality had a parameter constellation of 100kV, 70electronicmAs (78effectivemAs) and a pitch of 0.9 (DLP 63mGycm). This represented a dose reduction of 55%. A solely decrease of voltage lead to a dose reduction of 36% without any loss of image quality. An increase of the pitch factor to 1.5 and a decrease from 70 to 40mAs caused the most distinct impairment of image quality. In MDCT of the wrist good image quality could be maintained while radiation dose was considerably reduced. A reduction of voltage offers the best result for a solely parameter change. [Copyright &y& Elsevier]

Abstract: Purpose: To evaluate the diagnostic impact of MRI or/and multidetector CT in young patients with wrist injury and inconclusive or negative clinical examination and X-rays and to analyze variations in imaging strategies between a district general hospital (GH) and a university hospital (UH). Materials and methods: A retrospective analysis of 34 young patients (mean age 23 years) with wrist trauma who underwent CT or/and MRI was performed. The injury was acute in 24, and chronic in 10 patients. Twenty-two patients were from a GH and 12 from a UH. Two experienced musculoskeletal radiologists blindly reviewed the imaging studies. The effect of cross-sectional imaging on patient care and treatment plan was evaluated. Results: In 9 of 34 patients one or more fractures were diagnosed on cross-sectional imaging. The scaphoid was fractured in four patients, the lunate and/or the trapezium in three patients, the scaphoid together with the lunate in one patient, and finally the distal radius in one patient. Ligamentous trauma was identified solely on MRI in 11 patients (involving the TFCC in eight cases). In four patients with both imaging methods, CT revealed one fracture of the trapezium not seen on MRI, and one scapholunate fracture with MRI findings of distal radial fracture only. In two patients with normal CT, MRI revealed bone marrow oedema of the scaphoid in one and of the distal radius, lunate and triquetrum in the other. Conclusion: Both CT and MRI might be considered in patients with acute or chronic wrist injury, clinical dilemma and normal initial radiographs, depending on the availability and the individual institution policies. [Copyright &y& Elsevier]

Purpose: Lateral tilt (radially inclined) radiographs are useful after volar locked plate fixation of distal radius fractures to assess the radiocarpal joint, subchondral bone congruity, and volar tilt. The purpose of our study was to define the reliability of our positioning method using the patient''s opposite hand to position the injured wrist to obtain an inclined lateral radiograph with good visualization of the subchondral bone. Methods: A retrospective review identified adult patients who had a unilateral distal radius fracture treated with a volar locked plate and who had an initial postoperative lateral tilt radiograph using the contralateral hand to position the injured wrist. Intraoperative fluoroscopic images were reviewed to confirm the ability to see the extra-articular placement of all hardware. The inclined lateral wrist radiograph was obtained by positioning the injured wrist at a height determined by the contralateral hand being placed under the ulnar wrist crease. The wrist was then supported there with firm blocks in all cases. The radiographic beam was directed perpendicular to the horizontal cassette. Two reviewers (authors) then blindly reviewed postoperative radiographs to determine whether the radiocarpal joint and subchondral bone were visualized and whether any screws or pegs appeared to cross the radiocarpal joint. An accceptable lateral tilt radiograph was defined as good visualization of the subchondral bone while allowing only the most radial peg to appear to cross the joint. We also placed 15 normal volunteers into the lateral tilt position, using their opposite hand, to measure the inclined forearm angle. Results: A total of 24 wrists (24 patients) were identified and 23 patients had lateral tilt radiographs with acceptable visualization of the subchondral bone. The concordance of the subchondral bone visualization was 100% (95% confidence interval, 85.5% to 100%). The mean angle with lateral tilt positioning was 18° from horizontal (range, 15° to 23°; standard deviation, 2.4°). Conclusions: Using the contralateral hand to position the lateral inclined view, our lateral tilt position produced radiographs with reliable visualization of the distal radius subchondral bone in 96% of our cases. Visualization of the subchondral bone in the region of the radial aspect of the scaphoid fossa requires more tilt than is achieved with this technique. [Copyright &y& Elsevier]

Abstract: Purpose: To evaluate the diagnostic accuracy and indications of arthrography with Multidetector Computed Tomography (arthro-MDCT) of the wrist in patients with absolute or relative contraindications to magnetic resonance imaging (MRI) studies and in patients with periarticular metal implants using diagnostic arthroscopy as the gold standard. Materials and methods: After intra-articular injection of iodixanol and volumetric acquisition, 43 wrists in patients of both genders (18 females, 25 males, age range 32–60 years) were examined with a 16-detector-row CT scanner. Fifteen patients had prior wrist surgery. The patients had arthralgia, degenerative and traumatic arthropathies as well as limited range of motion, but no radiologically detected fractures. All examinations were interpreted by two experienced musculoskeletal radiologists. The findings were compared with arthroscopic findings carried out within 28 days of the CT study. Results: In non-operated and operated wrists the comparison between arthro-MDCT and arthroscopy showed sensitivity, specificity and accuracy ranging between 92% and 94% for triangular fibrocartilage complex (TFCC), between 80% and 100% for intrinsic ligaments located within the proximal carpal compartment, and between 94% and 100% for articular cartilage. Inter-observer agreement between two radiologists, in the evaluation of all types of lesions, was almost perfect (k =0.96) and statistically significant (p <0.05). Conclusions: Arthro-MDCT of the wrist provides an accurate diagnosis to identify chondral, fibrocartilaginous and intra-articular ligament lesions in patients who cannot be evaluated by MRI, and in post-surgical patients. [Copyright &y& Elsevier]

Purpose: To establish whether Madelung''s deformity demonstrates a radiographic continuum of severity and whether a forme fruste does exist. Methods: Ulnar tilt, lunate subsidence, palmar carpal displacement, and lunate fossa angle were measured in 81 wrist radiographs with obvious or suspected Madelung''s deformity. Statistical analyses based on these measurements were performed to ascertain if there is a deformity continuum. Results: Ranges of 15° to 51° (mean, 28°) for ulnar tilt, –7 to +11 mm (mean, –0.8 mm) for lunate subsidence, 9 to 25 mm (mean, 15.3 mm) for palmar carpal displacement, and 20° to 56° (mean, 33°) for lunate fossa angle were obtained. Significant correlations were observed between all measurements. Conclusions: Madelung''s deformity encompasses a spectrum of radiographic abnormality. Type of study/level of evidence: Diagnostic I. [Copyright &y& Elsevier]

Purpose: To study the articular morphology (radius of curvature), (diameter, depth, circularity, and percent of circle) of the capitate, proximal lunate, and the lunate fossa of the distal radius using both magnetic resonance imaging (MRI) scans and plain radiographs. The correlation between plain radiographs and MRI scans for these measurements will also be assessed. Methods: Twenty MRI scans and 17 sets of radiographs of asymptomatic volunteers were evaluated. Standardized surface landmarks were digitized and measured in both the sagittal and coronal planes. The parameters of interest were calculated from the digitized data using specialized software. Results: Using MRI data, we determined the radius of curvature of the capitate to be only 37% ± 10 of the lunate fossa of the distal radius on the coronal (anteroposterior) view and to be 57% ± 10 on the sagittal (lateral) view. In both planes, the proximal lunate had a significantly larger diameter and radius of curvature than did the capitate. The ratio of the radius of curvature of the proximal capitate to the proximal lunate on the coronal projection ranged from .366 to .811, and on the sagittal projection the values ranged from .46 to .71. Plain radiographs were not sufficiently accurate to determine the radius of curvature ratio of the capitate to the lunate or to the lunate fossa of the distal radius on the coronal view based on a comparison with MRI data. Plain radiography did not correlate with MRI for most clinically relevant parameters. Conclusions: The articular morphology of the capitate does not closely correspond with that of the lunate fossa when compared with the proximal lunate articular surface. Based on observed variations in capitate morphology and the potential for associated alterations in joint contact forces after proximal row carpectomy, preoperative MRI may facilitate the selection of patients with more favorable capitate morphology. [Copyright &y& Elsevier]

Background/purpose: The skeletal maturation status of a growing patient can influence the selection of orthodontic treatment procedures. Either lateral cephalometric or hand-wrist radiography can be used to assess skeletal development. In this study, we examined the correlation between the maturation stages of cervical vertebrae and hand-wrist bones in Taiwanese individuals.Methods: The study group consisted of 330 male and 379 female subjects ranging in age from 8 to 18 years. A total of 709 hand-wrist and 709 lateral cephalometric radiographs were analyzed. Hand-wrist maturation stages were assessed using National Taiwan University Hospital Skeletal Maturation Index (NTUH-SMI). Cervical vertebral maturation stages were determined by the latest Cervical Vertebral Maturation Stage (CVMS) Index. Spearman's rank correlation was used to correlate the respective maturation stages assessed from the hand-wrist bones and the cervical vertebrae.Results: The values of Spearman's rank correlation were 0.910 for males and 0.937 for females, respectively. These data confirmed a strong and significant correlation between CVMS and NTUH-SMI systems (p less than 0.001). After comparison of the mean ages of subjects in different stages of CVMS and NTU-SMI systems, we found that CVMS I corresponded to NTUH-SMI stages 1 and 2, CVMS II to NTUH-SMI stage 3, CVMS III to NTUHSMI stage 4, CVMS IV to NTUH-SMI stage 5, CVMS V to NTUH-SMI stages 6, 7 and 8, and CVMS VI to NTUH-SMI stage 9.Conclusion: Our results indicate that cervical vertebral maturation stages can be used to replace hand-wrist bone maturation stages for evaluation of skeletal maturity in Taiwanese individuals. [ABSTRACT FROM AUTHOR]

Summary: Purpose: To quantify the prevalence of radiographic hand osteoarthritis (OA) among a group of community-dwelling individuals. Joint-specific prevalence rates/100 of radiographic OA of the hand were quantified and reported by age, gender, and dominant hand. Methods: Data from a community-based, longitudinal study designed to follow the natural history of OA were used. Participants were ambulatory men and women, ages 40 years and older, with and without radiographic hand OA (N =3327). Bilateral hand OA was examined at three joints: second distal interphalangeal joints (DIP), third proximal interphalangeal joints (PIP), and first carpometacarpal joint of the thumb (CMC). The ordinal scale of Kellgren and Lawrence (0–4) was used to determine OA status (grades 2+). Results: Radiographic hand OA status was determined for all persons in the study group comprised of 2302 women (69%) and 1025 men (31%). The sample sizes for the age groups (years) were 532 (40–49), 905 (50–59), 998 (60–69), 749 (70–79), and 143 (80+). Overall, the DIP joint demonstrated the highest OA prevalence, while the PIP joint showed the lowest prevalence. Joint-specific hand OA prevalence rates for second DIP, third PIP, and first CMC were 35%, 18%, and 21%, respectively. Expectedly, hand OA prevalence for all joints increased with age. With exceptions, women demonstrated higher hand OA prevalence rates for the three sites examined. However, among men aged 40–49, the second DIP joint OA rate was higher (13%) compared with women (8%). Additionally, men in that age group demonstrated an elevated first CMC joint OA rate (9%) compared with women (5%). Gender-specific hand dominance analyses demonstrated that the majority of individuals with unilateral second DIP or third PIP OA presented in their dominant hand. However, among those with unilateral first CMC OA, both genders displayed a tendency to present in their nondominant hand. Conclusion: These findings suggest the need for further investigation of the role gender can play in the development of hand OA in populations under 60 years of age. Additional epidemiological studies addressing hand OA will serve to bridge the gap between the current levels of knowledge about the knee and the hand. The disease burden of hand OA affects a large percentage of the population. Research efforts that more exhaustively characterize the prevalence of hand OA may contribute toward interventions that, ultimately, impact a rapidly growing segment of our population. [Copyright &y& Elsevier]

Summary: The present study investigates the correlation between radiological parameters of wrist fractures and the clinical outcome expressed by objective clinical parameters and the level of patient-rated wrist dysfunction. Thirty consecutive cases of unstable distal radial fractures treated with closed reduction and percutaneous fixation were prospectively studied for a period of one year. The outcome parameters included objective clinical and radiological parameters and the previously described and validated patient-rated wrist evaluation (PRWE) score. Analysis showed that for unstable (AO classification types 23-A2, -A3, -C1 and -C2) fractures the fracture type affects the range of wrist palmarflexion (p =0.04) and that the presence of postoperative articular ‘step-off’ affects the range of wrist dorsiflexion and the patient-rated wrist function at the final time of the study (p <0.01 and p =0.02, respectively). It is also shown that permanent radial shortening and loss of the palmar angle were associated with prolonged wrist pain (p <0.01 and p =0.03, respectively). Our finding that residual articular incongruity correlates with persisting loss of wrist dorsiflexion and wrist dysfunction contradicts the view that loss of articular congruity is associated with late development of articular degeneration but not with early wrist dysfunction. Additionally, this study failed to show any association between the fracture type and the functional outcome as rated by the patients. [Copyright &y& Elsevier]

: Rationale and ObjectivesThe purpose of this study was (a) to demonstrate the feasibility of computing T1ρ maps of, and T1ρ dispersion in, human wrist cartilage at MR imaging in vivo and (b) to compare T1ρ and T2 weighting in terms of magnitude of relaxation times and signal intensity contrast.: Materials and MethodsT2 and T1ρ magnetic resonance images of wrist joints in healthy volunteers (n = 5) were obtained with a spin-echo sequence and a fast spin-echo sequence pre-encoded with a spin-lock pulse cluster. A 1.5-T clinical imager was used (Signa; GE Medical Systems, Milwaukee, Wis) with a 9.5-cm-diameter transmit-receive quadrature birdcage coil tuned to 63.75 MHz.: ResultsT1ρ relaxation times at a spin-lock frequency of 500 Hz vary from 40.5 msec ± 0.85 to 56.6 msec ± 4.83, and T2 relaxation times vary from 28.1 msec ± 1.88 to 34.5 msec ± 2.63 (mean ± standard error of the mean, n = 5, P < .016) in various regions of the wrist. T1ρ dispersion was observed in the range of spin-lock frequencies studied. T1ρ-weighted images not only have higher signal-to-noise ratios but also show better fluid and fat signal suppression than T2-weighted images.: ConclusionIt was possible to perform T2- and T1ρ-weighted MR imaging of human wrist cartilage in vivo with standard clinical imagers. The higher signal-to-noise ratio and improved contrast between cartilage and surrounding fat achieved with T1ρ imaging may provide better definition of lesions and accurate quantitation of small changes in cartilage degeneration. [Copyright &y& Elsevier]

The age estimation of the hand bones by means of X-ray examination is a pillar of the forensic age estimation. Since the associated radiation exposure is controversial, the search for ionizing radiation-free alternatives such as MRI is part of forensic research. The aim of the current study was to use the Greulich-Pyle (GP) atlas on MR images of the hand and wrist to provide reference values for assessing the age of the hand bones. 3T hand MR images of 238 male participants between the ages of 13 and 21 were acquired using 3D gradient echo sequences (VIBE, DESS). Two readers rated the images using the X-ray-based GP atlas method. A descriptive analysis and a transitional analysis were used for the statistical processing of the data. The agreement between and within the raters was assessed. In addition, a comparison was made with the chronological age and with X-ray studies. The descriptive analysis and the transition analysis showed similar results. Both evaluations showed good agreement with X-ray studies. The comparison with the chronological age showed a difference of 0.37 and 0.54 years for the two readers. The age estimate based on the cross-validated transition analysis showed a mean error of -0.28 years. Inter- and intra-rater agreement were good. In summary, it can be concluded that age estimation of hand bones with MR images is routinely applicable with the GP atlas as an alternative without ionizing radiation. However, in order to reduce the estimation error, a multi-factorial assessment based on examinations of several body regions is still recommended. [ABSTRACT FROM AUTHOR]

A response from the authors of the article "First dorsal interosseous muscle contraction results in radiographic reduction of healthy thumb carpometacarpal joint", which was published in the previous issues of the journal is presented.

The article presents the author's views on thumb carpometacarpal osteoarthritis patients. It mentioned that the thumb carpometacarpal (CMC) joint is commonly afflicted with degenerative change and is the most common form of arthritis in the hand. Topics discussed includes contraction of the first dorsal interosseous muscle (FDI), clinical decision making process surrounding treatment of individuals with thumb CMC and three-dimensional CT to attempt to account for dorsal subluxation.

A letter to the editor is presented in response to the article "First dorsal interosseous muscle contraction results in radiographic reduction of healthy thumb carpometacarpal joint" by C. McGee and colleagues, published in previous issues of the journal.