Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK.
Int J Surg. 2023 Jul 1;109(7):1919-1922. doi: 10.1097/JS9.0000000000000381.
A three-view radiographic examination (comprising of antero-posterior, oblique and lateral views) is crucial for the accurate assessment and subsequent decision-making in hand fracture management. The superiority of a three-view examination, compared to only two views, has been demonstrated by multiple studies, citing increased diagnostic accuracy and reduced rates of misdiagnosis. As such, the American College of Radiology (ACR) now recommends a standard three-view examination for finger and hand injuries; despite this, no formal guidance exists in the United Kingdom. Out of the 235 patients referred to our tertiary hand trauma unit with a confirmed hand fracture, less than half (45%) had three-view radiographic examination performed. Less than two-thirds (57%) of metacarpal fractures had three views available at assessment in our unit, with the lateral radiograph most commonly lacking (38%). Less than a third (30%) of phalangeal fractures had all three views, with the oblique view most commonly absent (64% of cases). Reviewed radiology protocols from six local hospitals were inconsistent; all recommended three views for suspected metacarpal fractures, but only two for suspected phalangeal injuries. Despite the superiority of a three-view examination and no additional cost of a third view, over half of the patients in this study lacked a three-view radiographic series. The authors would like to call for national published guidance advocating the use of three-view radiographic series in all patients with a high hand fracture suspicion (as defined by the presence of swelling, bruising and/or deformity) to reduce variability in local radiology hand fracture protocols and increase availability of three-view radiographs in the primary, secondary and tertiary settings.
对于手部骨折的管理，三视射线照相检查（包括前后位、斜位和侧位）对于准确评估和后续决策至关重要。多项研究表明，与仅进行两视图检查相比，三视图检查具有更高的诊断准确性和更低的误诊率。因此，美国放射学会（ACR）现在建议对手指和手部损伤进行标准的三视图检查；尽管如此，英国尚无正式指南。在我们的三级手部创伤单位，有 235 名确诊手部骨折的患者被转诊，其中不到一半（45%）进行了三视图射线照相检查。在我们的单位评估中，不到三分之二（57%）的掌骨骨折有三个视图，最常见的是缺少侧位片（38%）。不到三分之一（30%）的指骨骨折有所有三个视图，最常见的是缺少斜视图（64%的病例）。对六家当地医院的放射学协议进行了审查，结果不一致；所有医院都建议对疑似掌骨骨折进行三视图检查，但对疑似指骨损伤仅建议进行两视图检查。尽管三视图检查具有优越性，而且第三张视图不会增加额外成本，但在这项研究中，超过一半的患者缺乏三视图射线照相系列。作者希望呼吁制定国家发布的指南，主张在所有高度怀疑手部骨折的患者（定义为肿胀、瘀伤和/或畸形存在）中使用三视图射线照相系列，以减少当地放射学手部骨折方案的变异性，并增加初级、二级和三级环境中三视图射线照片的可用性。
