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DOI: 10.1148/radiol.2491071679
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(Radiology 2008;249:228-235.)
© RSNA, 2008

Musculoskeletal Imaging

Penetrating Volar Injuries of the Hand: Diagnostic Accuracy of US in Depicting Soft-Tissue Lesions1

Marc Soubeyrand, MD, David Biau, MD, Nabil Jomaah, MD, Clément Pradel, MD, Christian Dumontier, MD, PhD, and Geoffroy Nourissat, MD

1 From the Department of Radiology, Saint Antoine Hospital, Public Assistance Hospital of Paris, Paris, France. Received September 23, 2007; revision requested January 25, 2008; revision received March 19; accepted March 25; final version accepted April 21. Address correspondence to M.S., Department of Orthopaedic Surgery, Hôpital Universitaire de Bicêtre, AP-HP Paris, Bicetre, F-94270 Université de Paris-Sud, 78 rue du General Leclerc, 94275 Le Kremlin-Bicêtre, France (e-mail: soubeyrand.marc{at}wanadoo.fr).

Purpose: To evaluate the effectiveness of ultrasonography (US) in depicting lesions of the tendons, arteries, and nerves caused by penetrating wounds of the volar aspect of the hand, with surgical exploration as the reference standard.

Materials and Methods: Consecutive patients seen at one center over a 2-month period in 2006 were prospectively included. The institutional review board approved the study, and each patient gave written informed consent. There were 30 injuries in 26 patients (19 men and seven women; median age, 34 years). US examination was performed before surgery. Surgeons were not informed of the US findings. For tendons, arteries, and nerves, the sensitivity, specificity, positive predictive value, and negative predictive value of US were computed.

Results: US depicted all tendon lesions, with no false-positive findings; two arterial lesions were missed, with no false-positive findings, and four nerve lesions were missed, with six false-positive findings. The negative predictive value was 100% (95% confidence interval: 95.5%, 100%) for tendons, 96.7% (95% confidence interval: 88.7%, 99.6%) for arteries, and 93.7% (95% confidence interval: 84.5%, 98.2%) for nerves. In three cases, US depicted foreign bodies missed at surgery.

Conclusion: US was highly effective in identifying patients with no tendon or arterial lesions. Performance was poorer for diagnosing nerve lesions. US followed by a repeat physical examination after 72 hours to look for missed nerve damage may deserve evaluation as an alternative to routine surgical exploration when US findings are normal.

© RSNA, 2008