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Wrist Pain: X-rays and the Differential

4/26/2017

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Wrists are the most commonly injured upper extremity joint, and 8.8% of injuries are missed, with 2% being clinically important. With 27 bones and 34 muscles, there is a significant possibility of missing a fracture. A high index of suspicion is required to prevent missing a significant injury. 

Common Injuries

  • Colles Fracture
  • Smith Fracture
  • Scaphoid
  • scaphoid-lunate dislocation

Reading the AP view

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  1. Find the thumb: Orient yourself to the film
  2. Look at the radius: Identify dislocations, spacing changes, and fractures. The radius should end distal to the ulna in normal images. 
  3. Look at the scaphoid: Identify fractures
  4. Look at the carpal arches: Identify irregularities to the arches 
  5. Look at the Carpo-metacarpal junction: Identify metacarpal fractures or dislocations

Reading the Lateral view

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  1. Check the radial surface
  2. Check the dorsal surface
  3. Check for volar tilt: typically 10 degrees towards the palmar surface
  4. Check the posterior carpal space for triquetral fractures
  5. Identify the cup/saucer of the lunate.
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  • Clinical
    • Discharge Macros
    • Procedure Macros
    • Exam Macros
    • Pediatric Macros
    • Antibiogram
    • Follow Up
    • 2023 MDM
    • Heart Pathway
    • Jeromy's Macros
  • Education
    • EM Education
    • Critical Care
    • FOAM
  • Orientation
    • Dept Orientation
    • Cerner
    • Dragon
  • Links
    • Clinical Links
    • StatMacros
    • ICU Bootcamp
  • Private
    • MCS
    • GWU Contacts & Map