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Project: Ghana Emergency Medicine Collaborative
Document Title: Radiology: X-rays of the Hand and Wrist
Author(s): Christian Jacobus MD, Maine Medical Center, 2007
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Radiology:Radiology:X-rays of the Hand and X-rays of the Hand and
WristWristChristian Jacobus, MDChristian Jacobus, MD
April 11, 2007April 11, 2007
33
OverviewOverview
Brief review of normal radiographic Brief review of normal radiographic anatomyanatomy
CasesCases I give you mechanism, complaint, and X-I give you mechanism, complaint, and X-
rayray You give me diagnosis, treatment, and You give me diagnosis, treatment, and
eponymeponym Shameless unrelated entertainmentShameless unrelated entertainment
44
I Will not Cover…I Will not Cover…
Phalanx fracturesPhalanx fractures Soft tissue injuries (except that can Soft tissue injuries (except that can
be detected on plain film)be detected on plain film) Cross sectional imagingCross sectional imaging
55
Case 1Case 1
HyperextensionHyperextension Tender and Tender and
swollen thumbswollen thumb
1111Source undetermined
Case 1Case 1
Bennett FractureBennett Fracture Fx-Disloc of base of Fx-Disloc of base of
thumb MCthumb MC APL tendonAPL tendon
Splint, Hand referralSplint, Hand referral Will need ORWill need OR
1212
Source undetermined
Case 2Case 2
FOOSH, wrist painFOOSH, wrist pain Deformity to dorsal wristDeformity to dorsal wrist Decreased sensation to volar palmDecreased sensation to volar palm
1313
Case 2Case 2
Peri-lunate dislocationPeri-lunate dislocation Lunate remains articulated with Lunate remains articulated with
radiusradius Distal carpal bones translate dorsallyDistal carpal bones translate dorsally Emergent Hand consultEmergent Hand consult
1515
Case 3Case 3
Lunate dislocationLunate dislocation Disruption of all lunate ligamentsDisruption of all lunate ligaments Emergent Hand consultationEmergent Hand consultation
1717E-Hand.com, eatonhand.com
Case 4Case 4
Colles fractureColles fracture
2020
Sletuffe, Wikimedia CommonsAbigor, Wikimedia Commons
Case 4Case 4
Colles fractureColles fracture Distal metaphysis of the radiusDistal metaphysis of the radius Dorsal displacement and shorteningDorsal displacement and shortening
Silver fork deformitySilver fork deformity Reduction, splintingReduction, splinting Be alert for elbow and scaphoid injuriesBe alert for elbow and scaphoid injuries
2121
Case 5Case 5
GamekeeperGamekeeper’’s Thumb/Skiers Thumb/Skier’’s s Thumb/ BreakdancerThumb/ Breakdancer’’s Thumbs Thumb Disruption of the UCL of the thumb Disruption of the UCL of the thumb
MCPMCP Only visible on plain film when Only visible on plain film when
avulsion fx is presentavulsion fx is present Splint, Hand ReferralSplint, Hand Referral Will likely need ORWill likely need OR
2323
Case 6Case 6
Die-punch or lunate Die-punch or lunate load fractureload fracture
Axial force along Axial force along handhand
Splint, urgent Splint, urgent referralreferral
2626Source undetermined
Case 7Case 7
FOOSHFOOSH Pain and Pain and
tenderness to tenderness to base of thumb base of thumb and radial wristand radial wrist
2727Source undetermined
Case 7Case 7
Scapho-lunate dissociationScapho-lunate dissociation Terry Thomas/David Letterman signTerry Thomas/David Letterman sign
Scapho-lunate space >4mmScapho-lunate space >4mm SplintSplint Urgent f/uUrgent f/u
2828
Source undetermined
Case 8Case 8
Chauffeur's/Backfire/Hutchinson Chauffeur's/Backfire/Hutchinson FractureFracture
Direct blow to distal edge of radiusDirect blow to distal edge of radius Often scapholunate dissociationOften scapholunate dissociation Splint, urgent referralSplint, urgent referral
3131
Case 9Case 9
13 yo, FOOSH13 yo, FOOSH Pain to radial wristPain to radial wrist
3232Source undetermined
Case 9Case 9
Scaphoid fractureScaphoid fracture Frequently missedFrequently missed High litigationHigh litigation Splint, urgent Splint, urgent
handhand
3333Houston Methodist Orthopedics & Sport Medicine, methodistorthopedics.com
Case 9Case 9
Scapholunate Advance CollapseScapholunate Advance Collapse
3535
Source undetermined
Source undetermined
Case 10Case 10
Boxer's Boxer's fracturefracture
SplintSplint Hand referralHand referral
3737
Source undetermined
Case 10Case 10
Displacement in metacarpal fracturesDisplacement in metacarpal fractures ReduceReduce
> 10> 10° in 2 and 3° in 2 and 3 > 30° in 4 and 5> 30° in 4 and 5 Any rotationAny rotation
3838
Case 11Case 11
Triquetrum fractureTriquetrum fracture Most dorsal bone on lateralMost dorsal bone on lateral Dorsal fracture most commonDorsal fracture most common Splint, referralSplint, referral
4040
Case 12Case 12
14 yo boy14 yo boy Basketball Basketball
injuryinjury Wrist painWrist pain
4141
Source undetermined
Case 12Case 12
Normal adolescent wristNormal adolescent wrist Partially closed physesPartially closed physes SplintSplint
4242
Case 13Case 13
Thumb Thumb hyper-hyper-extensionextension
Tender Tender and and swollen swollen thumbthumb
4343Source undetermined
Case 13Case 13
Rolando FractureRolando Fracture AKA double-BennettAKA double-Bennett
Splint, Hand referralSplint, Hand referral Will need ORWill need OR
4444Source undetermined
Case 14Case 14
Tried to Tried to catch catch falling wine falling wine glassglass
4545Source undetermined
Case 15Case 15
Chauffeur fractureChauffeur fracture Splint, routine Hand referralSplint, routine Hand referral
4848
Case 16Case 16
Die-punch/Lunate load fractureDie-punch/Lunate load fracture Splint, urgent Hand referralSplint, urgent Hand referral
5050
Case 17Case 17
Scaphoid fractureScaphoid fracture Thumb spica splintThumb spica splint Urgent Hand referralUrgent Hand referral
5252
Case 18Case 18
Nintendo Wii Nintendo Wii accidentaccident
Thumb painThumb pain
5353Source undetermined
Case 18Case 18
Gamekeeper's thumbGamekeeper's thumb Thumb spicaThumb spica Urgent Hand referralUrgent Hand referral
5454
Case 19Case 19
Spiral fracture of second metacarpalSpiral fracture of second metacarpal Splint, referralSplint, referral
5656
Case 20Case 20
Dislocation of MCC joints 3-5Dislocation of MCC joints 3-5 Hand consultation, reductionHand consultation, reduction
5959
Case 23Case 23
Fall on supinated Fall on supinated handhand
Wrist painWrist pain
6262
Source undetermined
Case 23Case 23
Smith's fracture (aka reversed Colles)Smith's fracture (aka reversed Colles) Distal radiusDistal radius Impaction and volar displacementImpaction and volar displacement Reduction, splintReduction, splint
6363
Case 24Case 24
Peri-lunate dislocationPeri-lunate dislocation Emergent Hand consultationEmergent Hand consultation
6666
Case 25Case 25
Triquetral dorsal chip fractureTriquetral dorsal chip fracture SplintSplint Urgent Hand referralUrgent Hand referral
6969