When do Soft Tissue Injuries of Extremities without Obvious Deformity Require Radiography?

Abstract

Background: Emergency departments commonly treat soft tissue injuries to extremities. When to use radiography in cases without obvious deformity is unclear.

Objectives: To establish appropriate criteria for radiography in patients having soft tissue injuries of extremities without obvious deformity.

Methods: A cross-sectional study of 400 patients over 15 years old who presented with acute extremity injuries without obvious deformity from January 2007 – December 2009. Patients with polytrauma, neurosis, psychosis, alcoholism, gross fractures, neurological deficits, open injuries, inability to bear weight on injured lower extremities, and doubtful radiographs were excluded. Diagnosis for fracture by physical examination included swelling, ecchymosis, axial percussion test, generalized tenderness, bony point tenderness, and range of motion. Radiographs were obtained for all patients without knowing physical examination results.

Results: Fractures were present in 17.25% of soft tissue injuries without obvious deformity. The most accurate predictors of fracture were axial percussion test (88.50%) and bony point tenderness (73.50%). Positive and negative predictive values of physical diagnosis were 51.88% and 95.24%.

Conclusions: Axial percussion test and/or bony point tenderness should be followed by radiography due to their high accuracy. Other clinical signs such as swelling, generalized tenderness, and decreased range of motion were less than 32.50% accurate.