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Hand & Wrist

Hand & Wrist



  • Wrist views: AP, lateral, scaphoid views.
  • 3 carpal arches.
  • There are 4 stages of disruption of ligaments around the lunate.

A. Alignment: lateral view

  • Scapho-lunate ligament injury: note widened space between scaphoid and lunate.
  • Scapho-lunate dislocation: the lunate dislocates anteriorly, the concavity of the lunate is empty, the radius and capitate remain in a straight line. On AP view: the lunate adops a triangular ‘pie’ shape.
  • Perilunate dislocation: the capitate dislocates.
  • Distal radio-ulnar dislocation.

B. Bones

  • Distal radius & ulnar: look for Colles & Smiths fractures.
  • Most fractures of the wrist involve the scaphoid: the waist, which increases risk of AVN.
  • Some scaphoid fractures do not become apparent till 10 days after the injury.
  • Pooping duck sign! Characteristic of a triquetral fracture.

S. Soft tissue

  • Look for soft tissue swelling, which will point to the pathology.


A. Alignment

  • The 4th & 5th CMCJ are the most commonly dislocated. These are A/W hamate fractures.

B. Bones

  • Fighter’s fracture: fracture of 4th & 5th MC.
  • Boxer’s fracture: fracture of the 2nd & 3rd MC.
  • Look for intra-articular and rotated fractures asthese are unstable and require ORIF.
  • Unstable, intra-articular base of thumb fractures: Bennet’s (simple), Rolando’s (comminuted).
  • Game-keeper’s thumb: injury to the ulnar-collateral ligament at the 1st MCPJ +/- avulsion fracture.

S. Soft tissue

  • Look for soft tissue swelling, which will point to the pathology.


1. Goodman, L. and Felson, B. (2015). Felson's principles of chest roentgenology. 3rd ed. Philadelphia, PA: Elsevier, Saunders.
2. Dähnert W. Radiology Review Manual. LWW. (2011) ISBN:1609139437. Read it at Google Books - Find it at Amazon
3. Elizabeth Puddy, Catherine Hill; Interpretation of the chest radiograph, Continuing Education in Anaesthesia Critical Care & Pain, Volume 7, Issue 3, 1 June 2007, Pages 71–75, https://doi.org/10.1093/bjaceaccp/mkm014

Ⓒ A. Manickam 2018

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