E5139. Pearls for Finding Commonly Missed Upper Extremity Fractures
Authors
Nicholas Brandser;
Wake Forest School of Medicine
Evan Christopher Pohl;
Wake Forest School of Medicine
Leon Lenchik;
Wake Forest School of Medicine
Scott Wuertzer;
Wake Forest School of Medicine
Background
Nondisplaced fractures of the upper extremity can occasionally be difficult to find on routine radiographs. Soft tissue findings may aid with diagnosis. Our purpose is to provide pearls for finding commonly missed fractures of the hand, wrist, elbow, and shoulder.
Educational Goals / Teaching Points
Review the locations of commonly missed fractures of the elbow, wrist, hand, and shoulder. Discuss when ancillary soft tissue finding that can aid the diagnosis. Review when additional radiographic views, CT, or MRI should be obtained to confirm the diagnosis.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
In the hand, we show examples of nondisplaced volar plate fractures, gamekeeper’s fractures, and base of metacarpal fractures. In the wrist, we show examples of nondisplaced hamate, pisiform, lunate, and distal tubercle of scaphoid fractures. In the elbow, we show examples of nondisplaced radial neck, coronoid process, and capitellum fractures. In the shoulder, we show examples of nondisplaced scapular (acromion, coronoid, scapular body) and humerus (greater and lesser tuberosity) fractures.
Conclusion
Upper extremity fractures can be missed due to lack of symptoms, rarity of an injury, positioning of a patient, and artifacts. A systematic approach to finding these fractures is important.
