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Martti J Kiuru

Publications and source records attributed to Martti J Kiuru.

At least 19 recordsLinked to original sources
PubMed2007

Bilateral femoral fatigue fracture: an unusual fracture in a military recruit.

We present a case report of a military recruit who had bilateral fatigue fractures of the distal femur. Possible predisposing factors and the long-term outcome of these unusual stress fractures also are presented. A 19-year-old recruit experienced knee pain 2 weeks after starting his military service. Bilateral nondisplaced transverse fatigue fractures were detected radiographically in the supracondylar region on the right side and in the distal 1/3 of the femoral shaft on the left side. The fractures were treated with plaster casts for 5 weeks and healed properly. Osteopenia was seen in further examinations. At followup after 31 months followup the patient had fully resumed his previous athletic activity level and was symptom-free. Osteopenia still could be detected at the final examination. Nonoperative treatment with careful followup resulted in a favorable outcome in the nondisplaced bilateral distal fatigue femoral fractures in this patient.

Adult↗
PubMed2006

Bone stress injuries of the ankle and foot: an 86-month magnetic resonance imaging-based study of physically active young adults.

BACKGROUND: No comprehensive studies of bone stress injuries in the ankle and foot based on magnetic resonance imaging findings have been published. PURPOSE: Using magnetic resonance imaging findings to assess incidence, location, and type of bone stress injuries of the ankle and foot in military conscripts with ankle and/or foot pain. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: All patients with ankle or foot pain, negative findings on plain radiography, and magnetic resonance images obtained of the ankle or foot were included in this 86-month study. Magnetic resonance images with bone stress injury findings were re-evaluated regarding location and injury type. Based on the number of conscripts within the hospital catchment area, the person-based incidence of bone stress injuries was calculated. RESULTS: One hundred thirty-one conscripts displayed 378 bone stress injuries in 142 ankles and feet imaged, the incidence being 126 per 100 000 person-years. This incidence represents the stress injuries not diagnosable with radiographs and requiring magnetic resonance images. Of injuries, 57.7% occurred in the tarsal and 35.7% in the metatarsal bones. Multiple bone stress injuries in 1 foot were found in 63% of the cases. The calcaneus and fifth metatarsal bone were usually affected alone. Injuries to the other bones of the foot were usually associated with at least 1 other stress injury. The talus and calcaneus were the most commonly affected single bones. High-grade bone stress injury (grade IV-V) with a fracture line on magnetic resonance images occurred in 12% (talus, calcaneus), and low-grade injury (grade I-III) presented only as edema in 88% of the cases. CONCLUSION: Multiple, various-stage bone stress injuries of the ankle and foot may occur simultaneously in physically active young adults. When considering injuries that were missed by plain radiographs but detected by magnetic resonance imaging, the bones most often affected were the tarsal bones, of which the talus and calcaneus were the most prominent single bones and most common locations for higher grade (IV-V) bone stress injuries. With use of magnetic resonance imaging, early detection and grading of bone stress injuries are available, which enable early and appropriate injury management.

Adolescent↗
PubMed2006

Outcomes of stress fractures of the talus.

BACKGROUND: Stress fractures of the talus are rare, and only a few small studies have been published. In the absence of follow-up studies, the outcomes of these injuries are unknown. HYPOTHESIS: Traumatic fractures of the talus frequently heal poorly, and stress fracture healing might remain inadequate. The purpose of this study was to determine the outcome of stress fractures of the talus treated in the authors' institution with reduced exercise and nonweightbearing. STUDY DESIGN: Case series (prognosis); Level of evidence, 4. METHODS: Patients with a diagnosed stress fracture in the talus by magnetic resonance imaging between April 1997 and March 2005 were recalled for a follow-up inspection by an orthopaedic surgeon, magnetic resonance imaging, and plain radiographs to determine the outcome of the injury. RESULTS: One of the 9 patients in our sample declined the invitation, leaving 8 patients with 9 stress fractures in the talus who participated in the follow-up examination. Five patients displayed subchondral degeneration and edema near the original injury area in the follow-up magnetic resonance imaging. In 2 patients, the degeneration was also visible on the plain radiographs. Three patients had mild and 2 moderate symptoms after the mean follow-up time of 45 months (range, 12-74 months). No serious complications in the healing process were seen. CONCLUSION: Stress fractures of the talus do not seem to seriously damage the foot. In a middle-term follow-up, however, minor to moderate symptoms and radiological degeneration of the injured area prevailed in roughly half of the patients.

Adult↗
PubMed2006

Bone stress injuries of the talus in military recruits.

The purpose of the present study was to assess the incidence, anatomic distribution, and nature of fatigue bone stress injuries of the talus in military recruits based on magnetic resonance imaging (MRI). Military recruits referred to MRI examination due to exercise-induced ankle and/or foot pain were identified from the MRI archives. MR images of cases with bone stress injury findings in the talus were retrospectively re-evaluated concerning the anatomic location and type of the bone stress injury. During 96 months, fifty-one consecutive recruits displayed bone stress injuries of the talus in the population base of 117,149 person-years, yielding an incidence of 4.4 (3.2-5.5)/10,000 person-years. Bilateral injuries were seen in five of the patients. Of the 56 bone stress injuries, 40 occurred in the head, 15 in the body, and 5 in the posterior part of the talus. In four cases, both the head and the body were affected. Solitary, the talus was affected in 12 cases. In 44 cases, a stress injury was also present in other tarsal bones. Assessing the severity of the bone stress injury, a grade I-III injury was found in 46 and a grade IV injury with a fracture line in 10 of the cases. Injuries of the upper part of the body were associated with calcaneal stress injuries in 78% of the cases (P=0.03), and injuries of the head of the talus were associated with stress injuries in the naviculare in 60% of the cases (P=0.04). Age, sex, height, weight, body mass index, or physical fitness failed to reach statistical significance as risk factors for fatigue bone stress injuries of the talus. On MRI, the majority of the bone stress injuries of the talus were revealed in the head. A grade IV injury was discovered in 18% of the cases; in the remaining 82%, only grade I-III injuries were ascertained. In all locations, the lower grade bone stress injuries dominated. This study established the incidence of fatigue bone stress injury of the talus and indicated that these injuries are rare but not unseen in military recruits.

Adolescent↗
PubMed2006

Sensitivity of routine 1.0-Tesla magnetic resonance imaging versus arthroscopy as gold standard in fresh traumatic chondral lesions of the knee in young adults.

PURPOSE: The purpose of this study was to evaluate the sensitivity, specificity, and accuracy of routine 1.0-Tesla magnetic resonance imaging (MRI) versus arthroscopy in detecting fresh traumatic chondral lesions of the knee. METHODS: Over a period of 6 years, 578 consecutive military personnel underwent MRI before arthroscopy of the knee. Of these, 32 patients with arthroscopically proven fresh traumatic chondral lesions of the knee were chosen for further analysis. A supplementary condition was that arthroscopy was performed no later than 6 weeks after the onset of trauma. The original MRIs and hospital records were re-evaluated and the chondral lesions were graded and compared with arthroscopic findings. The arthroscopic results served as the gold standard when the sensitivity, specificity, and accuracy of MRI were calculated. RESULTS: The age of the patients ranged from 19 to 21 years (mean, 19.6 years). MRI detected cartilage defects with a sensitivity of 36% (95% confidence interval [CI], 23% to 50%), specificity of 91% (95% CI, 85% to 95%), and diagnostic accuracy of 78% (95% CI, 72% to 83%). MRI results were affected by the grade of the chondral lesions. CONCLUSIONS: This study shows that routine 1.0-T MRI is not sensitive but is specific and somewhat accurate in detecting fresh traumatic articular cartilage lesions. The hypothesis of this study was that 1.0-T MRI could replace diagnostic arthroscopy in the diagnosis of fresh traumatic chondral lesions. Our results fail to support this hypothesis because of the poor sensitivity obtained with MRI. LEVEL OF EVIDENCE: Level II, development of diagnostic criteria.

Adult↗
PubMed2006

Fatigue bone injuries causing anterior lower leg pain.

UNLABELLED: Shin splints, or stress-related anterior lower leg pain, seem to arise from numerous causes, including stress fractures. We retrospectively reviewed 154 consecutive military patients who had magnetic resonance imaging during a 5-year period for stress-related anterior lower leg pain. Using magnetic resonance imaging, 143 bone stress injuries were diagnosed in 86 of the 154 (56%) patients. The incidence of bone stress injury requiring orthopaedic consultation and magnetic resonance imaging among recruits during the 5 years was 117 per 100,000 person years in military service. The bone stress injury was located in the tibia in 141 (99%) patients. Of these injuries, 80 (57%) were located in the distal (1/3) of the tibial shaft, 42 (30%) in the middle (1/3), 14 (10%) in the proximal (1/3), and five (3%) in the medial condyle. The locations of tibial stress injuries related to the magnetic resonance imaging grades. Almost all lower leg fatigue bone stress injuries were located in the tibia, and the distal lateral shaft was affected most often. When used early after onset of symptoms, magnetic resonance imaging provides accurate diagnosis to ensure appropriate treatment, especially when dealing with exercise-induced lower leg pain in physically active patients. LEVEL OF EVIDENCE: Diagnostic study, Level II (development of diagnostic criteria on consecutive patients [with universally applied reference "gold" standard]). See the Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗
PubMed2006

Displaced femoral neck fatigue fractures in military recruits.

BACKGROUND: Displaced fatigue fractures of the femoral neck are uncommon, but they can lead to substantial patient morbidity. This study was performed to examine the incidence, long-term consequences, radiographic findings, risk factors, and complications associated with this fracture. METHODS: Between 1975 and 1994, twenty-one military recruits sustained a displaced fatigue fracture of the femoral neck. Nineteen patients were followed for an average of eighteen years. Data regarding the population at risk, hospital records, initial and follow-up radiographs, and physical findings were analyzed. The impact of instructions from the Finnish Defense Forces, Department of Medical Services, provided in 1986 for prevention of femoral neck fatigue fractures was assessed. RESULTS: At our institution, the incidence of displaced fatigue fractures of the femoral neck was 5.3/100,000 service years from 1975 to 1986, prior to the introduction of the prevention regimen in 1986, and it was 2.3/100,000 service years (95% confidence interval, 0.11 to 1.31) from 1987 to 1994. The rate of Garden type-IV fractures decreased from 3.8 to 0/100,000 service years (95% confidence interval, 0 to 0.66) between the first and second time-periods. The detection of nondisplaced symptomatic fatigue fractures of the femoral neck increased from 15.5 to 53.2/100,000 service years (95% confidence interval, 2.27 to 5.21) between the two time-periods. Eighteen of the nineteen patients had had prodromal symptoms prior to the fracture displacement. Following fracture treatment, six patients had delayed union or nonunion of the fracture. Osteonecrosis of the femoral head developed in six patients and was significantly associated (p = 0.001) with shortening of the femoral neck. Severe osteoarthritis developed in eight patients. CONCLUSIONS: A displaced fatigue fracture of the femoral neck leads to long-term morbidity in a high percentage of patients. Most patients have prodromal symptoms, which provide an opportunity to prevent fracture displacement. Our results indicate that, in a military setting, an educational program can diminish the incidence of fatigue fracture displacement by increasing the awareness of these fractures and their prodromal symptoms and by facilitating diagnosis in the early stages before displacement occurs. LEVEL OF EVIDENCE: Therapeutic Level III.

Adult↗
PubMed2006

Stress injuries of the calcaneus detected with magnetic resonance imaging in military recruits.

BACKGROUND: Calcaneal stress injuries are fairly common overuse injuries in military recruits and athletes. We assessed the anatomic distribution, nature, and healing of calcaneal stress injuries in a group of military recruits. METHODS: Military recruits who underwent magnetic resonance imaging for the evaluation of exercise-induced ankle and/or heel pain were identified from the medical archives. The magnetic resonance images, plain radiographs, and medical records of these patients were evaluated with regard to fracture type and the natural history of the injury. RESULTS: Over ninety-six months, magnetic resonance imaging revealed calcaneal stress injuries in thirty recruits in a population with a total exposure time of 117,149 person-years, yielding an incidence of 2.6 (95% confidence interval, 1.6 to 3.4) per 10,000 person-years. Four patients exhibited a bilateral injury. Of the thirty-four injuries, nineteen occurred in the posterior part of the calcaneus, six occurred in the middle part of the calcaneus, and nine occurred in the anterior part of the calcaneus, with 79% occurring in the upper region and 21% occurring in the lower region. The calcaneus alone was affected in twelve cases. In twenty-two cases, stress injury was also present in one or several other tarsal bones. A distinct association emerged between injuries of the different parts of the calcaneus and stress injuries in the surrounding bones. In only 15% of the patients was the stress injury visible on plain radiographs. With the numbers available, there were no significant differences between the patients with calcaneal stress injuries and unaffected recruits with regard to age, height, weight, body mass index, or physical fitness. CONCLUSIONS: The majority of stress injuries of the calcaneus occur in the posterior part of the bone, but a considerable proportion can also be found in the middle and anterior parts. To obtain a diagnosis, magnetic resonance imaging is warranted if plain radiography does not show abnormalities in a physically active patient with exercise-induced pain in the ankle or heel.

Adolescent↗
PubMed2005

The incidence and distribution of burst fractures.

This study was conducted to assess occurrence and distribution of burst fractures as well as common accident mechanisms and the associated neurologic deficit. Using picture archiving and communications system, all emergency multidetector computed tomography studies over 34 months were retrieved and evaluated for burst fractures by two radiologists by consensus. Initial neurological findings were retrieved from patients' medical records. One hundred fifty-two patients (112 male) with a total of 169 burst fractures were found. In both genders, the incidence of burst fractures peaked at the thoracolumbar junction and between levels T5 and T8. In 10% of cases, more than one burst fracture was seen, thereof 53% on noncontiguous levels. Main accident mechanisms were falls, traffic, and sports. Neurological deficit was highest in patients with burst fractures of the cervical spine, independent of accident mechanism, and lowest in thoracolumbar junction fractures. Burst fractures occur frequently in high energy traumas and are most commonly associated with falling and traffic accidents. Multiple burst fractures occur in 10% of cases, half thereof on noncontiguous levels.

Adult↗
PubMed2005

Bone stress injuries causing exercise-induced knee pain.

BACKGROUND: No comprehensive studies of bone stress injuries in the knee based on magnetic resonance imaging findings have been published. PURPOSE: Assess the incidence, location, nature, and patterns of bone stress injuries in the knee in military conscripts with exercise-induced knee pain. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: During a period of 70 months, 1330 patients with exercise-induced knee pain underwent magnetic resonance imaging of the knee. A total of 1577 knees were imaged; the images with bone stress injury findings were retrospectively reevaluated with respect to location and type of injury. The person-based incidence of bone stress injuries in the knee was calculated, based on the number of conscripts within the hospital's catchment area. RESULTS: Of the 1330 patients, 88 (7%) met the inclusion criteria, and 141 bone stress injuries were found in the 110 knees imaged. The incidence of bone stress injuries was 103 per 100 000 person-years. Of the patients, 25% had bilateral bone stress injuries; 28% had 2 solitary bone stress injuries in the same knee simultaneously, all situated in the femoral condyle and tibial plateau. The most common anatomical location for a bone stress injury was the medial tibial plateau (31%), which was also the most typical location for a more advanced injury. After the commencement of military service, a bone stress injury in the medial tibial plateau caused knee pain earlier than did a bone stress injury elsewhere in the knee (P = .014). CONCLUSION: The incidence of bone stress injuries in the knee with exercise-induced knee pain is relatively high in conscripts. Multiple and bilateral injuries can occur. For accurate diagnosis and to ensure appropriate treatment, magnetic resonance imaging is recommended as a routine imaging method when a physical activity can be regularly associated with the onset of symptoms.

Adolescent↗
PubMed2005

Diagnostic value of pelvic radiography in the initial trauma series in blunt trauma.

The purpose of the study was to evaluate the diagnostic value of pelvic radiography in the initial trauma series when compared to multidetector CT (MDCT) findings in serious blunt trauma. Inclusion criteria were blunt trauma and pelvic radiography in the initial trauma series, followed by a whole-body MDCT. A total of 1386 patients (874 male, 512 female, age 16-91 years, mean 41 years) met the inclusion criteria. Imaging studies were evaluated retrospectively by anatomical region and classified, when possible, using the Tile classification. Based on MDCT, a total of 629 injuries occurred in 226 (16%) of these 1386 patients. Radiography depicted 405 fractures in these 226 patients, giving an overall sensitivity of 55%. In 24 patients (11%) radiography was false-negatively normal. The sensitivity of radiography was mainly good in the anteroinferior parts of the pelvis, fair in the acetabulum and ileum, and poor in the posterior ring. By MDCT 141 (62%) patients were classified using the Tile classification and by radiography 133 patients (59%) were classified. MDCT and radiography showed the same type of pelvic injury in 72 patients (59%) and the subtype in 17 patients (14%). In 48 patients (40%) the pelvis was shown to be stable by radiography but unstable by MDCT. In conclusion, the sensitivity of pelvic radiography is low, and it is not reliable for determining if the pelvic injury is stable or not.

Adult↗
PubMed2005

Effect of ultrasound therapy on bone healing of lateral malleolar fractures of the ankle joint fixed with bioabsorbable screws.

BACKGROUND: We investigated the effect of low-intensity ultrasound on bone healing in bioabsorbable self-reinforced poly-L: -lactic acid (SR-PLLA) screw-fixed lateral malleolar fractures. The study design was prospective, randomized, double-blind, and placebo-controlled. METHODS: A total of 22 fractures were fixed with one SR-PLLA screw. All the patients were instructed to use an ultrasound device 20 min daily for 42 days without knowing whether it was active or inactive. Eleven patients had active and eleven sham ultrasound devices. The causes of error during treatment with head module placement and attachment to the convex surface of the lateral distal fibula were minimized by careful targeting and using coupling gel. Radiological fracture healing was assessed by radiographs and multidetector computed tomography (CT) scans in a blinded manner by a radiologist and orthopedic surgeons. RESULTS: The overall compliance to the daily ultrasound treatments was good. All wounds healed uneventfully, and no foreign body reactions were observed. No difference was observed between the groups regarding either fracture line visualization or callus formation assessed by plain radiographs. In the CT images at 9 weeks, the share of the endosteal united fracture line compared to the non-united fracture line was slightly higher in the active ultrasound device group than in the sham ultrasound device group, but the difference was not statistically significant. CONCLUSION: The study indicates that the biocompatibility of ultrasound therapy and bioabsorbable SR-PLLA screw fixation is good. There was no obvious effect of low-intensity ultrasound on lateral malleolar fracture healing. However, the relatively small number of patients must be kept in mind when interpreting our results. It is also important to limit any conclusions based on the present study to malleolar fractures fixed with the SR-PLLA screw.

Adolescent↗
PubMed2005

Bone stress injuries in asymptomatic elite recruits: a clinical and magnetic resonance imaging study.

BACKGROUND: The occurrence and clinical significance of asymptomatic bone stress injuries is unknown. HYPOTHESIS: To evaluate by clinical and magnetic resonance imaging follow-up the occurrence of asymptomatic bone stress injuries, their clinical significance, and whether they all progress to stress fractures in subjects undergoing intensive physical training. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 1. METHODS: Twenty-one male elite-unit military recruits voluntarily underwent clinical examination and magnetic resonance imaging before their intensive training period, 6 weeks into it, and on completion of the 5-month training program. RESULTS: Based on magnetic resonance imaging, a total of 75 bone stress injuries were detected. Only 40% (30/75) of the bone stress injuries had been symptomatic. Symptoms depended on location and magnetic resonance imaging grade of injury, with higher grades usually more symptomatic. Repeated clinical and magnetic resonance imaging assessment indicated that asymptomatic grade I bone stress injuries healed (21/25, 84%) or remained grade I and asymptomatic (3/25, 12%). The numbers of bone stress injuries, symptomatic cases, and recruits with bone stress injury increased toward the end of the intensive training period. CONCLUSIONS: Asymptomatic grade I bone stress injuries seem common in subjects undergoing intensive physical training. Such bone stress injuries heal or remain asymptomatic grade I bone stress injuries even if intensive physical activity continues. They are therefore of no clinical significance. Only subjects who exhibit symptoms need undergo imaging studies. Subjects with an asymptomatic grade I bone stress injury may continue training but should be clinically monitored for symptoms.

Adult↗
PubMed2004

Radicular lower extremity pain as the first symptom of primary hyperparathyroidism.

Clinical symptoms of hyperparathyroidism are generally nausea, vomiting, fatigue, constipation, and hypotonicity of the muscles and ligaments; bone pain and tenderness are also seen but are more common in secondary hyperparathyroidism. We report a histologically confirmed case of a 28-year-old man whose sole symptom of primary hyperparathyroidism was lower extremity radicular pain due to a vertebral brown tumor. Magnetic resonance imaging demonstrated brown tumor to be hyperintense on T2-weighted and slightly hypointense on T1-weighted sequences; it showed intense contrast enhancement with gadolinium. Because brown tumors usually contain hemosiderin a short T2 should have been expected, but this was not seen in our case. Healing resulted in decreasing contrast enhancement on T1-weighted sequences and increasingly short T2. To our knowledge, this is the first report of a lumbar vertebral brown tumor associated with primary hyperparathyroidism.

Adenoma↗
PubMed2004

Multidetector CT in shoulder fractures.

The aim of this study was to assess the multi-detector computed tomography (MDCT) findings in acute shoulder traumas compared to radiographic findings in patients referred to a level one trauma center. Two hundred and ten patients (128 male, 82 female, age 16-95 years, mean age 51.7 years) underwent shoulder MDCT due to acute trauma. Three main mechanisms of injury were established: falling (113 patients, 54%), traffic accidents (36 patients, 17%) and falling from a height (12 patients, 6%). Based on MDCT, a total of 311 fractures--152 in the scapula and 159 in the proximal humerus--occurred in 191 (91%) of the 210 patients. The two most common occult fractures were lesser tubercle and coracoid process fractures. In 20 (63%) of the patients with a comminuted fracture of proximal humerus the exact number of fracture fragments was underestimated in radiographs. MDCT with multiplanar reconstructions (MPR) is a recommended complementary examination in patients with complex proximal humerus fractures where the extent of the fractures and the position or origin of dislocated fragments is not clear on radiography. This may increase the accuracy of the fracture classification and reveal occult fractures in other parts of the shoulder.

Adolescent↗
PubMed2004

Ankle and foot injuries: analysis of MDCT findings.

OBJECTIVE: The purpose of our study was to assess MDCT findings and the advantages of MDCT compared with radiography in patients referred to a level 1 trauma center for diagnostic evaluation of acute ankle and foot trauma. MATERIALS AND METHODS: During a period of 37 months, 388 patients underwent MDCT of the ankle and foot due to an acute trauma. Imaging studies (MDCT and radiography) were retrospectively reevaluated with respect to fracture location, fracture type, and mechanism of injury, and findings from the primary radiographs of the ankle and foot were compared with MDCT findings. RESULTS: Of the 388 patients, 344 (89%) had one or more fractures in the ankle or foot. A total of 517 fractures were found in all anatomic regions: ankle, calcaneus, talus, midfoot, and forefoot. The three most common occult fractures in the ankle not detected on primary radiography were isolated fractures of the posterior and medial malleolus and Tillaux fractures. The calcaneus was the most commonly fractured bone, and the sensitivity of radiography in the detection of calcaneal fractures was 87%. The sensitivity of radiography in the detection of talar fractures was 78%, whereas it was only 25-33% in the detection of midfoot fractures. A Lisfranc fracture-dislocation was not detected on primary radiography in five (24%) of 21 cases. The three main injury mechanisms were falling from a height (164 patients [48%]), a simple fall (68 patients [20%]), and a traffic accident (47 patients [14%]). CONCLUSION: In patients with injuries from high-energy polytrauma and in those with complex ankle and foot fractures, the sensitivity of radiography is only moderate to poor; in these cases, MDCT is recommended as the primary imaging technique.

Adolescent↗
PubMed2003

Wrist injuries; diagnosis with multidetector CT.

The aim of the study was to assess acute-phase multidetector CT (MDCT) findings in wrist injuries. We retrieved all emergency room MDCT requests processed in the period from August 2000 to May 2003. All patients with a wrist injury who underwent MDCT initially were included. Imaging studies were evaluated in relation to injury mechanism, fracture location, and fracture type. A total of 6422 MDCT examinations were performed during this 34-month period, and 38 patients (24 male, 14 female, age range 21-73 years, mean age 40 years) met the inclusion criteria. MDCT revealed 56 fractures and 7 dislocations in 29 patients. In 9 patients (24%) MDCT findings were normal. Eleven patients (29%) underwent surgical procedures. The main injury mechanism was a fall (58%). In 33 cases the primary radiograph was available. Compared to primary radiographs, MDCT revealed 9 occult fractures, mainly in small carpal bones. In 14 cases a suspected fracture (of the scaphoid in 7 cases) was ruled out by MDCT. Due to high-quality two-dimensional reformatting, MDCT examinations were not dependent on the wrist's position in the CT gantry. In the comparison with radiography, MDCT detected occult fractures and ruled out suspected fractures, both mainly in the small carpal bones. High-quality two-dimensional reformats gave significant information about the fracture anatomy. MDCT provides fast and valuable information in assessing complex wrist fractures or when the primary radiograph is equivocal.

Adult↗