Diagnostic Failure Rate in Detecting Perilunate Carpal Fractures and Dislocations Using Plain Wrist X-Rays^[*]

Abstract

Objectives The present study aimed to evaluate the diagnostic failure rate in detecting perilunate fractures and dislocations using plain wrist radiographs by orthopedists and orthopedic residents. A secondary objective was to identify possible groups with a greater or lesser chance of establishing a correct diagnosis.

Methods An online questionnaire was sent to several orthopedists through e-mail, social networks, and smartphone-based communication applications to assess the rate of diagnostic failure in detecting perilunate fractures and dislocations using plain radiographs.

Results A total of 511 responses was obtained, with a diagnostic error rate of 8.81% for simple dislocations and 1.76% for trans-scaphoid perilunate fractures. Group stratification showed that residents presented the highest error rates in simple perilunate dislocations (23.91%), whereas hand surgeons presented the lowest error rates (1.74%).

Conclusion Compared with the literature, the failure rates found were lower, suggesting that plain radiography is effective and that the error rate may not be as high as reported.

Keywords

carpal bones/injuries - wrist injuries - joint dislocations - fractures, bone

• Referências

• 1 Chiappini A, Alessandri M. Considerations on the bloodless reduction of a case of perilunar luxation of the carpus with fracture of the scaphoid and of the styloid apophysis of the radius. Ann Med Nav (Roma) 1964; 69: 399-410
• 2 Pappas III ND, Lee DH. Perilunate Injuries. Am J Orthop 2015; 44 (09) E300-E302
• 3 Gilula LA. Carpal injuries: analytic approach and case exercises. AJR Am J Roentgenol 1979; 133 (03) 503-517
• 4 Hildebrand KA, Ross DC, Patterson SD, Roth JH, MacDermid JC, King GJ. Dorsal perilunate dislocations and fracture-dislocations: questionnaire, clinical, and radiographic evaluation. J Hand Surg Am 2000; 25 (06) 1069-1079
• 5 Mayfield JK, Johnson RP, Kilcoyne RK. Carpal dislocations: pathomechanics and progressive perilunar instability. J Hand Surg Am 1980; 5 (03) 226-241
• 6 Herzberg G, Comtet JJ, Linscheid RL, Amadio PC, Cooney WP, Stalder J. Perilunate dislocations and fracture-dislocations: a multicenter study. J Hand Surg Am 1993; 18 (05) 768-779
• 7 Herzberg G, Forissier D. Acute dorsal trans-scaphoid perilunate fracture-dislocations: medium-term results. J Hand Surg [Br] 2002; 27 (06) 498-502
• 8 Meszaros T, Vögelin E, Mathys L, Leclère FM. Perilunate fracture-dislocations: clinical and radiological results of 21 cases. Arch Orthop Trauma Surg 2018; 138 (02) 287-297
• 9 Garcia-Elias M, Irisarri C, Henriquez A. et al. Perilunar dislocation of the carpus. A diagnosis still often missed. Ann Chir Main 1986; 5 (04) 281-287
• 10 Google. Google Forms. Disponível em: [Acesso em 1 de Julho de 2018] https://www.google.com/forms/about/
• 11 Hosmer DW, Lemeshow S. Assessing the fit of the model. In: Applied Logistic Regression. New York: John Wiley and Sons; 1989: 135-173
• 12 Scheffer M, Cassenote A, Guilloux AG, Biancarelli A, , Bruno, Miotto A, Mainardi GM. Demografia Médica no Brasil 2018. São Paulo: Departamento de Medicina Preventiva da Faculdade de Medicina da USP; Conselho Regional de Medicina do Estado de São Paulo; Conselho Federal de Medicina; 2018
• 13 Çolak I, Bekler HI, Bulut G, Eceviz E, Gülabi D, Çeçen GS. Lack of experience is a significant factor in the missed diagnosis of perilunate fracture dislocation or isolated dislocation. Acta Orthop Traumatol Turc 2018; 52 (01) 32-36
• 14 Dunn JC, Koehler LR, Kusnezov NA. et al. Perilunate Dislocations and Perilunate Fracture Dislocations in the U.S. Military. J Wrist Surg 2018; 7 (01) 57-65
• 15 Orton DI, Gruzelier JH. Adverse changes in mood and cognitive performance of house officers after night duty. BMJ 1989; 298 (6665): 21-23