Occult radiocarpal fractures often present a diagnostic challenge to the emergency department. Accurate diagnosis of these injuries is crucial as a missed fracture can lead to significant morbidity. Cone-beam CT (CBCT) scan is a novel imaging modality, with minimal radiation exposure and comparatively fast acquisition time. Our aim was to evaluate its use in the diagnosis of cortical fractures in the upper limb extremity./r/nWe conducted a systematic review of literature and included all studies that evaluated the use of CBCT in the diagnosis of radiocarpal fractures. We used a mixed-effects logistic regression bivariate model to estimate the summary sensitivity and specificity and constructed hierarchical summary receiver operative characteristic curves (HSROC)./r/nWe identified 5 studies, with 439 patients, and observed CBCT to be 87.7% (95% CI 77.6-93.6) sensitive and 99.2% (95% CI 92.6-99.9) specific for scaphoid fractures. For carpal fractures, CBCT was observed to have a pooled sensitivity and specificity of 90.6% (95% CI 72.7-97.2) and 100% (95% CI 99-100) respectively. For distal radius fractures, CBCT sensitivity was 90% (95% CI 67-98) and specificity was 100% (95% CI 10-100). The overall inter-rater agreement effect was shown to be 0.89 (95% CI 0.82-0.96), which is deemed to be almost perfect./r/nCBCT is an accurate diagnostic tool for occult radiocarpal cortical fractures, which could replace or supplement radiographs. We believe CBCT has a promising role in the acute radiocarpal fracture diagnostic algorithm in both emergency and trauma departments.