Multiple occult wrist bone injuries and joint effusions: prevalence and distribution on MRI

This study aims (1) to assess the prevalence and distribution of multiple occult injuries of the carpal bones and the distal forearm in patients with wrist pain and negative radiographs following trauma and (2) to evaluate the distribution and significance of joint effusions in the wrists with multiple osseous injuries. One hundred and thirty-one subjects, 74 men and 57 women, were consecutively examined in two institutions. All were acute trauma patients with negative X-rays whose clinical examination suggested possible fracture at the wrist or the distal forearm. Magnetic resonance (MR) wrist imaging was performed with and without fat saturation sequences. The MR images were analysed for detection of occult trabecular contusions and cortical discontinuity in the carpus, the distal forearm and the metacarpal bases. The prevalence and distribution of the injuries were assessed along with the distribution of joint effusions. Eight patients were excluded due to inadequate image quality. Two patients had bilateral injury. A total of 125 wrists were analysed. Seventy-eight (62.4%) wrists had occult bone injuries. Among these 78, 53 (68%) wrists had more than one injured bone. Twenty-five wrists (32%) had one injured bone. The highest number of injured bones per wrist was six. Injuries with a visible fracture line were seen in 29 (37.1%) wrists on MRI. The distal radius was the most frequent location for occult fracture line (11 cases). The injuries without a fracture line (contusion) were present in 49 (63%) wrists; they were detected more frequently in the scaphoid (35 cases). The lunate (29 cases) and the triquetrum (26 cases) were almost equally affected. The bone that was less frequently injured was the pisiform (four cases). Joint effusions were present in all 53 wrists with multiple bone lesions but more often situated in the ulnocarpal space 27 (50.3%) wrists]. There was no correlation between effusions in multiple locations (grades III and IV) and multiple bone injuries. This study revealed the presence of multifocal trabecular contusions without correlation with increased joint effusions in patients with negative radiographs and persistent pain. The clinical significance of these findings deserves further investigation.