Diagnostic accuracy of oblique radiographic views for ulnar-sided carpometacarpal dislocations: A cadaveric study
In brief
A 60-degree oblique X-ray best detects fifth carpometacarpal dislocations
In images from six cadaver hands reviewed by 20 orthopedic surgeons, the 60-degree view had the highest overall accuracy and sensitivity for detecting fifth carpometacarpal dislocations. Its specificity was lower, and detection was not reliable enough to use this view alone; computed tomography is recommended when suspicion remains despite unclear X-rays.
- Journal
- Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES (Q2)
- Published
- 1 November 2026
- Study design
- Unclassified
- Evidence level
- Level 5, Expert Opinion (CEBM 5)
- Authors
- Omar Aljasim, Can Yener, Mesut Demirkoparan, Arman Vahabi, Ali Engin Daştan, Okan Bilge, et al.
- PMID
- 42993031
- DOI
- 10.14744/tjtes.2026.17529
Why clinicians should know about it
- Picked for Anatomy (top studies of the week, 8 November 2026): Cadaveric study links hand anatomy to diagnostic radiographic views
Abstract
BACKGROUND: Dislocations and fracture-dislocations of the ulnar-sided carpometacarpal (CMC) joints are rare injuries that are often overlooked during initial clinical evaluations, primarily due to subtle radiographic findings and overlapping anatomical structures. Missed or delayed diagnosis can result in chronic instability, persistent pain, and suboptimal functional outcomes. This study aimed to assess and compare the diagnostic sensitivity and specificity of different oblique radiographic projections in identifying fifth CMC joint dislocations using a controlled cadaveric model. METHODS: Six human cadaveric hands, preserved with the modified Larssen solution, were used in this study. Oblique fluoroscopic images were acquired at 30°, 45°, and 60° angles from the lateral view, under three different joint conditions: Native alignment, 25% dislocation, and 50% dislocation of the fifth CMC joint. Standardized imaging was performed using a fixed digital setup. A total of 54 randomized images were included in a questionnaire reviewed by 20 orthopedic surgeons (7 consultants and 13 senior registrars), who classified the fifth CMC joint status as 'dislocated,' 'not dislocated,' or 'uncertain.' Sensitivity, specificity, and overall diagnostic accuracy were calculated for each oblique angle. RESULTS: The 60° oblique radiographs exhibited the highest sensitivity for identifying dislocations but had a moderate reduction in specificity. In contrast, the 30° view showed the highest specificity but the lowest sensitivity. The 45° oblique radiographs provided a more balanced diagnostic profile. Overall, the 60° oblique radiographs achieved the greatest diagnostic accuracy. Interestingly, senior registrars demonstrated significantly higher diagnostic accuracy than consultants. CONCLUSION: While the 60° oblique radiographs showed the best performance in detecting fifth CMC dislocations, their sen-sitivity was not sufficient for use as a standalone diagnostic tool. When clinical suspicion persists despite inconclusive radiographs, computed tomography scan is recommended.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.