Book contents
- Frontmatter
- Dedication
- Contents
- List of contributors
- Introduction
- Acknowledgments
- List of abbreviations
- Section 1 Principles of surgery
- Section 2 General surgery
- Section 3 Breast surgery
- Section 4 Pelvis and perineum
- Section 5 Orthopaedic surgery
- Section 6 Vascular surgery
- Section 7 Heart and thorax
- Section 8 Head and neck surgery
- Section 9 Neurosurgery
- Section 10 Plastic surgery
- Section 11 Surgical radiology
- 44 Principles of plain film
- 45 Chest x-ray
- 46 Abdominal x-ray
- 47 Mammogram
- 48 Facial x-ray
- 49 Cervical spine x-ray
- 50 Shoulder x-ray
- 51 Elbow x-ray
- 52 Wrist and distal forearm x-ray
- 53 Pelvis and hip x-ray
- 54 Knee x-ray
- 55 Foot and ankle x-ray
- 56 Principles of CT
- 57 Head CT
- 58 Chest CT
- 59 Abdomen CT
- 60 Aorta CT
- 61 Kidneys, ureter and bladder CT
- 62 Lower limb CT angiogram
- Section 12 Airway, trauma and critical care
- Index
52 - Wrist and distal forearm x-ray
from Section 11 - Surgical radiology
Published online by Cambridge University Press: 05 July 2015
- Frontmatter
- Dedication
- Contents
- List of contributors
- Introduction
- Acknowledgments
- List of abbreviations
- Section 1 Principles of surgery
- Section 2 General surgery
- Section 3 Breast surgery
- Section 4 Pelvis and perineum
- Section 5 Orthopaedic surgery
- Section 6 Vascular surgery
- Section 7 Heart and thorax
- Section 8 Head and neck surgery
- Section 9 Neurosurgery
- Section 10 Plastic surgery
- Section 11 Surgical radiology
- 44 Principles of plain film
- 45 Chest x-ray
- 46 Abdominal x-ray
- 47 Mammogram
- 48 Facial x-ray
- 49 Cervical spine x-ray
- 50 Shoulder x-ray
- 51 Elbow x-ray
- 52 Wrist and distal forearm x-ray
- 53 Pelvis and hip x-ray
- 54 Knee x-ray
- 55 Foot and ankle x-ray
- 56 Principles of CT
- 57 Head CT
- 58 Chest CT
- 59 Abdomen CT
- 60 Aorta CT
- 61 Kidneys, ureter and bladder CT
- 62 Lower limb CT angiogram
- Section 12 Airway, trauma and critical care
- Index
Summary
Introduction
‘This is an AP/lateral/oblique radiograph of the right/left wrist, or scaphoid series.’
Views
• AP and lateral.
Anatomy
Bones
• Distal radius and ulna.
• Carpal bones: scaphoid, lunate, triquetral, pisiform, trapezium, trapezoid, capitate, hamate.
• If the lunate is anteriorly displaced this is termed a lunate dislocation.
• If the lunate (which is moon-shaped – with the concave side holding the rest of the carpus) – or cup of the lunate are empty then this is termed a perilunate dislocation – the capitate is displaced dorsally.
• Space > 2 mm between scaphoid and lunate is abnormal (scapholunate dissociation) (Terry Thomas sign).
Lines
• Normal radius has palmar/volar tilt (2–20°). If lost, suspect a fracture of the radius.
• Radial wrist normally more distal than ulna. If lost, this may suggest that the radius has impacted and is shortened.
• Dorsal angulation fracture of radius = Colles’ fracture.
• Volar angulation fracture of radius = Smith's fracture.
• If there is an intra-articular fracture involving either the posterior cortex or more commonly the anterior cortex of the radius, the vertical fracture pattern causes subluxation of the carpal bones= Barton's fracture (unstable).
Pathology
Radius fractures
• Fractures involving the growth plate. Salter–Harris classification:
I S – Straight through
II A – Above/metaphyseal
III L – Lower/epiphyseal
IV T – Through both metaphyisis and epiphysis
V S – Squashed
• Colles’ and Smith's fractures: distal radial fracture with no joint involved.
• Barton-type fracture: distal radial fracture that is longitudinal and involves the joint space; it can have a volar or dorsal angulation and is associated with carpal displacement (unlike Colles’ or Smith's).
Scaphoid
• Tenderness in anatomical snuffbox: ask for four-view scaphoid series.
• Normal radiographs but clinical suspicion: treat as fracture and repeat radiographs in 10–14 days.
• 80% waist: most common fracture (avascular necrosis likely).
• 10% proximal pole (avascular necrosis very likely).
• 10% distal pole (avascular necrosis unlikely).
• Scaphoid fractures may be associated with perilunate dislocation.
- Type
- Chapter
- Information
- Physical Examination for SurgeonsAn Aid to the MRCS OSCE, pp. 426 - 432Publisher: Cambridge University PressPrint publication year: 2015