A pilot study to identify clinical predictors for wrist fractures in adult patients with acute wrist injury.

BACKGROUND: To date, no clinical decision rules for acute wrist injuries are available. In the past, clinical decision rules for the knee, ankle and spine injuries have been developed and validated. Implementation of these rules resulted in standardised clinical assessment at the emergency department and a substantial reduction of radiographic diagnostics. The objective of the study was to identify predictors for wrist fractures in patients with acute wrist injury which might potentiate a clinical decision rule in the future. This is a prospective pilot study in adult patients presenting with acute wrist injury at the emergency department of the Canisius-Wilhelmina Hospital in the Netherlands.

METHODS: Clinical variables were collected in a case report file by emergency physicians. Radiography was ordered according to common practice to confirm or rule out the presence of fractures. Independent associations between the presence of clinical variables and wrist fractures were calculated. Multivariable analysis was performed in order to quantify sensitivity and specificity for fracture prediction.

RESULTS: A total of 63 wrist fractures were detected in the study population of 95. Age over 55 years, inability to carry weight directly after trauma, support of injured wrist by the contralateral hand for pain relief, presence of swelling and/or hematoma, visible wrist deformity and reduced range of motion were associated with the presence of a wrist fracture.

CONCLUSIONS: Our study identified clinical predictors for wrist fractures in patients with acute wrist injury. Future studies are needed for justification of evidence-based wrist assessment and identification of a 100% sensitive decision rule for wrist fractures.