The Utility of Plain Radiography in Flexor Tendon and Digital Nerve Lacerations of the Hand.

Purpose: Physical examination during hand lacerations may sufficiently identify flexor tendon and digital nerve injuries, but radiographs are often acquired to rule out fracture, dislocation, or foreign body. This study examines the impact of plain radiography in the management of patients with isolated sharp injuries of the hand. Methods: We retrospectively reviewed consecutive adult patients with flexor tendon and/or digital nerve lacerations who presented during 2019-2021 to a tertiary referral urgent care hand clinic. Charts were reviewed to determine the presence of bony injury or foreign body and whether radiographic evaluation affected clinical management. Comparisons were made among patients with varying mechanisms. Results: One hundred eighty-five patients met inclusion criteria, with the mechanisms of sharp laceration (83.2%), saw injury (11.9%), and crush injury (4.9%). All patients with saw and crush injuries received radiographs compared with 45.5% in the sharp laceration group. Bony injuries and/or foreign bodies were found in 63.6% and 66.7% of cases in the saw and crush groups, respectively. In comparison, no patients with sharp lacerations had a bony injury, and one patient had a foreign body from glass shattering that was removed in the emergency department. Conclusions: Our results suggest that the utility of plain radiography in sharp lacerations may be limited to clinical contexts in which a retained foreign body is suspected. We recommend only selective use of radiography in isolated sharp lacerations of the hand; however, radiographs regularly altered management in injuries because of saw and crush mechanisms and would be warranted in these settings. Clinical relevance: This study supports the judicious use of radiography in simple sharp lacerations of the volar hand.