A 32-year-old male construction worker sustains a crush injury to his left forearm after a steel beam falls on it. Plain radiographs show a comminuted fracture of the radius and ulna with soft tissue swelling. The attending surgeon suspects an intra-articular extension at the wrist joint. Which investigation is most appropriate to confirm the intra-articular involvement and guide surgical planning?

Explanation

## Investigation of Choice for Intra-articular Fracture Assessment ### Why CT with 3D Reconstruction is Optimal **Key Point:** High-resolution CT with 3D reconstruction is the gold standard for evaluating comminuted fractures with suspected intra-articular extension, particularly in the wrist and forearm. **Clinical Pearl:** CT provides: - Precise delineation of fracture fragments and their spatial relationships - Clear visualization of intra-articular involvement - Accurate assessment of articular surface displacement - 3D reconstruction aids preoperative surgical planning and implant selection ### Why CT Excels in This Scenario | Feature | CT with 3D | MRI | Ultrasound | Repeat X-rays | |---------|-----------|-----|-----------|---------------| | **Bone detail** | Excellent | Poor | Poor | Limited | | **Fragment count** | Precise | Moderate | Poor | Inadequate | | **Intra-articular extension** | Excellent | Moderate | Poor | Inadequate | | **Surgical planning** | Optimal | Moderate | Poor | Suboptimal | | **Speed** | Fast | Slow | Fast | Fast | | **Cost-effectiveness** | Moderate | High | Low | Low | **High-Yield:** In comminuted fractures with suspected intra-articular involvement, CT is superior because: 1. It shows the exact number and position of bone fragments 2. It reveals subtle articular surface steps (even <2 mm) 3. It guides fixation strategy (ORIF vs. external fixation) 4. 3D reconstruction allows virtual surgical planning **Mnemonic: CT-PLAN** — **C**lear **T**hree-dimensional **P**icture for **L**arge **A**rticular **N**avigation