Prevalence of missed wrist and ankle traumatic injuries: systematic review and meta-analysis

The wrist and ankle are complex and injury-prone anatomical regions that can be overlooked when evaluated with conventional radiography. Delayed treatment of an occult lesion impacts the quality of life of the patient and the resources of the health system. Objective: The objective of the study was to determine the prevalence of occult traumatic injuries to the wrist and ankle using simple radiography in the general population. Materials and methods: A systematic search was carried out in the Medline, CINAHL, Scopus, Cochrane library, Embase, Google Scholar, OpenGray, and Proquest databases. A meta-analysis of proportions was performed to estimate the prevalence of occult bone lesions. Results: In the wrist, the global prevalence of occult traumatic injuries was 36% (95% confidence interval [95% CI]: 24.0-49.0), and in adults, it was 31% (95% CI: 20.0-43.0). In the ankle, the overall prevalence of occult traumatic injuries was 34% (95% CI: 19.0-51.0) and 47% in adults (95% CI: 38.0-56.0). Conclusion: The results of the meta-analysis show a significant global prevalence of occult traumatic injuries for the wrist of 36% and for the ankle of 34%, for which it is important to take into account a systematic approach for the interpretation of radiographic images of the wrist and ankle to mitigate diagnostic errors.