Title : Evaluating the use of plain film radiographs in hand and wrist trauma at a major tertiary centre
Abstract:
Introduction: Hand and wrist injuries are common emergency presentations (Manley et al., 2019), for which plain film radiographs are increasingly utilised (Sahu et al., 2014), being able to assess underlying fractures, foreign bodies and joint injury. However, University Hospitals Birmingham (UHB) lacks clear guidelines on indications and appropriate X-ray views. We evaluated the effectiveness, potential overuse and view adequacy of radiographs in hand and wrist trauma in UHB.
Methods: Our retrospective study analysed data from 100 patients seen in the Hot Hand Clinic in Queen Elizabeth Hospital, Birmingham in October 2024, using eHands software. Collected data included patient demographics, referring hospital, clinical and radiographic details, and any additional imaging required. Data was recorded in a predefined Microsoft Excel spreadsheet for analysis.
Results: Radiographs didn't alter management for 28 patients (28%), commonly involving sharp cuts and animal bites. In 6 patients (6%), all from other UHB hospitals, inadequate views resulted in repeat imaging, with true lateral views being commonly repeated. 2 patients (2%) with complex wrist injuries required further CT imaging.
Conclusion: Managing hand and wrist injuries relies heavily on clinical history and examination, and plain radiographs must also be an additional fundamental investigation. Whilst three views may not be essential for all cases, oblique and true lateral views have high negative predictive values (Hassan et al., 2020), reducing the need for repeat radiographs and avoiding excessive radiation exposure. Standardising criteria for radiographs in hand and wrist injuries across the UHB Trust is required for efficiency.
