Gibney B, et al. - A prospective review was carried out on all individuals who had cone-beam CT investigation of acute wrist pain after normal initial radiographs in order to evaluate the outcome of adding cone-beam CT to the standard imaging algorithm for individuals with suspected radiographically occult traumatic radiocarpal fractures. Overall, 117 individuals were evaluated, of which 50.4% had fractures recognized with a total of 67 radiographically occult fractures. In individuals with negative wrist radiographs yet ongoing clinical concern for radiocarpal fracture, including cone-beam CT into routine clinical practice as part of a standardized diagnostic algorithm gave a 50% fracture detection rate. Cone-beam CT gives more diagnostic information compared with radiographs at a lower radiation dose vs conventional MDCT. Thus, cone-beam CT should be acknowledged as the new standard of care in the investigation of these cases provided the poor accuracy of radiographs for acute radiocarpal fractures and the high fracture prevalence in this cohort.