Orthopaedic Clinic Wrist RadiographyThis is a featured page

Introduction
There are significant differences in radiography provided in an acute setting to a non-acute setting. In large hospitals, most of the acute orthopaedic radiography will occur in the X-ray rooms which service the Emergency Department. Patients who have orthopaedic injuries requiring follow-up will be seen at orthopaedic clinic and they are usually referred for follow-up radiography of their injury. This page considers wrist radiography techniques that are more commonly employed in follow-up orthopaedic examinations.

Why Follow-up Treated Orthopaedic Injuries?

The simple answer to this question is that there can be a variety of unexpected outcomes including non-union and changes in fracture alignment. A patient with a healed fracture can have immobilisation/support devices removed.


Case 1

This 14 year old boy presented to the Emergency Department after falling onto an outstretched hand. He had a painful and swollen wrist and was referred for right wrist radiography.
PA wristLateral Wrist
There is a fracture of the distal radius which appears undisplaced in this view.The fractured distal radius is demonstrated on the lateral view with minor dorsal angulation.

The patient received a fibreglass plaster and arrangements were made for the patient to return to orthopaedic clinic in 2 weeks to assess the healing of the fracture.

forearmforearm
Mixed views of the forearm were performed at follow-up. The radiographer had little choice given that the forearm was in this position when the fibreglass cast was applied. The distal radius fracture is demonstrated with minimal displacement.This position demonstrates the wrist in lateral position and the elbow in AP/oblique position. The distal radius shows considerable displacement and angulation requiring surgical correction.

Comment
Isolated fractures of the distal radius tend to displace late and get stuck (http://www.orthospot.com.au/papers.orthospot.com.au/fracupl_files/frame.htm). This plaster shows a lack of mould points which may have precipitated the angular displacement of the distal radius fracture.




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AndyC
AndyC
Latest page update: made by AndyC , Feb 8 2010, 1:05 AM EST (about this update About This Update AndyC Moved from: Lateral Condylar Elbow Fractures - AndyC

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cullensr Modified lateral wrist 0 Nov 4 2009, 5:25 PM EST by cullensr
Thread started: Nov 4 2009, 5:25 PM EST  Watch
Hi Michael,

I have noticed that there is a link to an article called about fixation screws impinging on wrist joints. I am hoping you are going to discussed a modified lateral wrist where the elbow is flexed 15 degrees raising the wrist joint from the plate and opening the joint between radius/ulnar and carpals. Perhaps this is still under construction but just wanted to note that I am really keen to see matching images as I have heard this view is done at some of our centres but I haven't seen any images yet. I am going to attempt this view in a lab next week but I suspect our wrist phantoms are not quite accurate enough to acheive the view.

Cheers,

Rachel
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