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A multi-use x-ray system with cone-beam CT (CBCT) option facilitates ancillary 3-D imaging without repositioning. We assessed the clinical value of CBCT scans by analyzing the influence of additional findings on therapy.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Ninety-two patients underwent radiography and subsequent CBCT imaging with the twin robotic scanner (76 wrist\/hand\/finger and 16 ankle\/foot\/toe trauma scans). Reports by on-call radiologists before and after CBCT were compared regarding fracture detection, joint affliction, comminuted injuries, and diagnostic confidence. An orthopedic surgeon recommended therapy based on reported findings. Surgical reports (<jats:italic>N<\/jats:italic>\u2009=\u200952) and clinical follow-up (<jats:italic>N<\/jats:italic>\u2009=\u200985) were used as reference standard.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>CBCT detected more fractures (83\/64 of 85), joint involvements (69\/53 of 71), and multi-fragment situations (68\/50 of 70) than radiography (all <jats:italic>p\u2009&lt;\u20090.001<\/jats:italic>). Six fractures suspected in radiographs were ruled out by CBCT. Treatment changes based on additional information from CBCT were recommended in 29 patients (31.5%). While agreement between advised therapy before CBCT and actual treatment was moderate (<jats:italic>\u03ba<\/jats:italic>\u2009=\u20090.41 [95% confidence interval 0.35\u20130.47]; <jats:italic>p\u2009&lt;\u20090.001<\/jats:italic>), agreement after CBCT was almost perfect (<jats:italic>\u03ba<\/jats:italic>\u2009=\u20090.88 [0.83\u20130.93]; <jats:italic>p\u2009&lt;\u20090.001<\/jats:italic>). Diagnostic confidence increased considerably for CBCT studies (<jats:italic>p\u2009&lt;\u20090.001<\/jats:italic>). Median effective dose for CBCT was 4.3\u00a0\u03bcSv [3.3\u20135.3\u00a0\u03bcSv] compared to 0.2\u00a0\u03bcSv [0.1\u20130.2\u00a0\u03bcSv] for radiography.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>CBCT provides advantages for the evaluation of acute small bone and joint trauma by detecting and excluding extremity fractures and fracture-related findings more reliably than radiographs. Additional findings induced therapy change in one third of patients, suggesting substantial clinical impact.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Key Points<\/jats:title>\n                <jats:p><jats:italic>\u2022 With cone-beam CT, extremity fractures and fracture-related findings can be detected and ruled out more reliably than with conventional radiography.<\/jats:italic><\/jats:p>\n                <jats:p><jats:italic>\u2022 Additional diagnostic information provided by cone-beam CT scans has substantial impact on therapy in small bone and joint trauma.<\/jats:italic><\/jats:p>\n                <jats:p><jats:italic>\u2022 For distal extremity injury assessment, one-stop-shop imaging without repositioning is feasible with the twin robotic x-ray system.<\/jats:italic><\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00330-020-07563-5","type":"journal-article","created":{"date-parts":[[2020,12,5]],"date-time":"2020-12-05T23:02:20Z","timestamp":1607209340000},"page":"3600-3609","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Twin robotic x-ray system in small bone and joint trauma: impact of cone-beam computed tomography on treatment decisions"],"prefix":"10.1007","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4524-1620","authenticated-orcid":false,"given":"Jan-Peter","family":"Grunz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lenhard","family":"Pennig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tabea","family":"Fieber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carsten Herbert","family":"Gietzen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julius Frederik","family":"Heidenreich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henner","family":"Huflage","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Gruschwitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp Josef","family":"Kuhl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Petritsch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksander","family":"Kosmala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thorsten Alexander","family":"Bley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Gassenmaier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,12,5]]},"reference":[{"key":"7563_CR1","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1016\/j.injury.2006.04.130","volume":"37","author":"CM Court-Brown","year":"2006","unstructured":"Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: a review. 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The authors of this manuscript declare no further relationships with any companies, whose products or services may be related to the subject matter of the article.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"No complex statistical operations were used in this manuscript.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Informed consent was waived by the Institutional Review Board of the University of W\u00fcrzburg, Germany (IRB-Nr. 20200226 01).","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Study permission was obtained from the Institutional Review Board of the University of W\u00fcrzburg, Germany (IRB-Nr. 20200226 01).","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"\u2022 Retrospective\u2022 Observational\u2022 Performed at one institution","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}},{"value":"Siemens Healthineers Multitom Rax VF10 with 3-D function is not available in all countries and its future availability cannot be guaranteed.","order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclaimer"}}]}}