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1 Project: Ghana Emergency Medicine Collaborative Document Title: Radiology: X-rays of the Hand and Wrist Author(s): Christian Jacobus MD, Maine Medical.

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Presentation on theme: "1 Project: Ghana Emergency Medicine Collaborative Document Title: Radiology: X-rays of the Hand and Wrist Author(s): Christian Jacobus MD, Maine Medical."— Presentation transcript:

1 1 Project: Ghana Emergency Medicine Collaborative Document Title: Radiology: X-rays of the Hand and Wrist Author(s): Christian Jacobus MD, Maine Medical Center, 2007 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability to use, share, and adapt it. These lectures have been modified in the process of making a publicly shareable version. The citation key on the following slide provides information about how you may share and adapt this material. Copyright holders of content included in this material should contact with any questions, corrections, or clarification regarding the use of content. For more information about how to cite these materials visit Any medical information in this material is intended to inform and educate and is not a tool for self-diagnosis or a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. Please speak to your physician if you have questions about your medical condition. Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers.

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3 Radiology: X-rays of the Hand and Wrist Christian Jacobus, MD April 11,

4 Overview Brief review of normal radiographic anatomy Brief review of normal radiographic anatomy Cases Cases I give you mechanism, complaint, and X-ray I give you mechanism, complaint, and X-ray You give me diagnosis, treatment, and eponym You give me diagnosis, treatment, and eponym Shameless unrelated entertainment Shameless unrelated entertainment 4

5 I Will not Cover… Phalanx fractures Phalanx fractures Soft tissue injuries (except that can be detected on plain film) Soft tissue injuries (except that can be detected on plain film) Cross sectional imaging Cross sectional imaging 5

6 Carpal Bones 6 Source undetermined

7 Normal Wrist PA 7 Source undetermined

8 Normal Wrist Lateral 8 Source undetermined

9 Normal Hand PA 9 Source undetermined

10 Normal Hand Lateral 10 Source undetermined

11 Case 1 Hyperextension Hyperextension Tender and swollen thumb Tender and swollen thumb 11 Source undetermined

12 Case 1 Bennett Fracture Bennett Fracture Fx-Disloc of base of thumb MC Fx-Disloc of base of thumb MC APL tendon APL tendon Splint, Hand referral Splint, Hand referral Will need OR Will need OR 12 Source undetermined

13 Case 2 FOOSH, wrist pain FOOSH, wrist pain Deformity to dorsal wrist Deformity to dorsal wrist Decreased sensation to volar palm Decreased sensation to volar palm 13

14 Case 2 14 Source undetermined

15 Case 2 Peri-lunate dislocation Peri-lunate dislocation Lunate remains articulated with radius Lunate remains articulated with radius Distal carpal bones translate dorsally Distal carpal bones translate dorsally Emergent Hand consult Emergent Hand consult 15

16 Case 3 FOOSH, pain in wrist FOOSH, pain in wrist 16 Source undetermined

17 Case 3 Lunate dislocation Lunate dislocation Disruption of all lunate ligaments Disruption of all lunate ligaments Emergent Hand consultation Emergent Hand consultation 17 E-Hand.com, eatonhand.com

18 Case 4 FOOSH FOOSH Pain in wrist Pain in wrist 18

19 Case 4 19 Source undetermined

20 Case 4 Colles fracture Colles fracture 20 Sletuffe, Wikimedia Commons Abigor, Wikimedia Commons

21 Case 4 Colles fracture Colles fracture Distal metaphysis of the radius Distal metaphysis of the radius Dorsal displacement and shortening Dorsal displacement and shortening Silver fork deformity Silver fork deformity Reduction, splinting Reduction, splinting Be alert for elbow and scaphoid injuries Be alert for elbow and scaphoid injuries 21

22 Case 5 Skier Skier Tender and swollen thumb Tender and swollen thumb 22 Source undetermined

23 Case 5 Gamekeeper’s Thumb/Skier’s Thumb/ Breakdancer’s Thumb Gamekeeper’s Thumb/Skier’s Thumb/ Breakdancer’s Thumb Disruption of the UCL of the thumb MCP Disruption of the UCL of the thumb MCP Only visible on plain film when avulsion fx is present Only visible on plain film when avulsion fx is present Splint, Hand Referral Splint, Hand Referral Will likely need OR Will likely need OR 23

24 Case 5 24 Source undetermined 3-Point Products, 3pointproducts.com

25 Case 6 Punched a wall Punched a wall Wrist pain Wrist pain 25 Source undetermined

26 Case 6 Die-punch or lunate load fracture Die-punch or lunate load fracture Axial force along hand Axial force along hand Splint, urgent referral Splint, urgent referral 26 Source undetermined

27 Case 7 FOOSH FOOSH Pain and tenderness to base of thumb and radial wrist Pain and tenderness to base of thumb and radial wrist 27 Source undetermined

28 Case 7 Scapho-lunate dissociation Scapho-lunate dissociation Terry Thomas/David Letterman sign Terry Thomas/David Letterman sign Scapho-lunate space >4mm Scapho-lunate space >4mm Splint Splint Urgent f/u Urgent f/u 28 Source undetermined

29 Case 7 29 Source undetermined

30 Case 8 Assaulted with bat Assaulted with bat Wrist pain Wrist pain 30 Source undetermined

31 Case 8 Chauffeur's/Backfire/Hutchinson Fracture Chauffeur's/Backfire/Hutchinson Fracture Direct blow to distal edge of radius Direct blow to distal edge of radius Often scapholunate dissociation Often scapholunate dissociation Splint, urgent referral Splint, urgent referral 31

32 Case 9 13 yo, FOOSH 13 yo, FOOSH Pain to radial wrist Pain to radial wrist 32 Source undetermined

33 Case 9 Scaphoid fracture Scaphoid fracture Frequently missed Frequently missed High litigation High litigation Splint, urgent hand Splint, urgent hand 33 Houston Methodist Orthopedics & Sport Medicine, methodistorthopedics.com

34 Case 9 34 Source undetermined

35 Case 9 Scapholunate Advance Collapse Scapholunate Advance Collapse 35 Source undetermined

36 Case 10 Punched a wall Punched a wall Hand pain Hand pain 36 Source undetermined

37 Case 10 Boxer's fracture Boxer's fracture Splint Splint Hand referral Hand referral 37 Source undetermined

38 Case 10 Displacement in metacarpal fractures Displacement in metacarpal fractures Reduce Reduce > 10° in 2 and 3 > 10° in 2 and 3 > 30° in 4 and 5 > 30° in 4 and 5 Any rotation Any rotation 38

39 Case 11 FOOSH FOOSH Dorsal wrist pain Dorsal wrist pain 39 Source undetermined

40 Case 11 Triquetrum fracture Triquetrum fracture Most dorsal bone on lateral Most dorsal bone on lateral Dorsal fracture most common Dorsal fracture most common Splint, referral Splint, referral 40

41 Case yo boy 14 yo boy Basketball injury Basketball injury Wrist pain Wrist pain 41 Source undetermined

42 Case 12 Normal adolescent wrist Normal adolescent wrist Partially closed physes Partially closed physes Splint Splint 42

43 Case 13 Thumb hyper- extension Thumb hyper- extension Tender and swollen thumb Tender and swollen thumb 43 Source undetermined

44 Case 13 Rolando Fracture Rolando Fracture AKA double-Bennett AKA double-Bennett Splint, Hand referral Splint, Hand referral Will need OR Will need OR 44 Source undetermined

45 Case 14 Tried to catch falling wine glass Tried to catch falling wine glass 45 Source undetermined

46 Case 14 Hand foreign body Hand foreign body Significant litigation Significant litigation 46

47 Case 15 Nightstick injury Nightstick injury 47 Source undetermined

48 Case 15 Chauffeur fracture Chauffeur fracture Splint, routine Hand referral Splint, routine Hand referral 48

49 Case 16 Punched a wall Punched a wall Wrist pain Wrist pain 49 Source undetermined

50 Case 16 Die-punch/Lunate load fracture Die-punch/Lunate load fracture Splint, urgent Hand referral Splint, urgent Hand referral 50

51 Case 17 FOOSH FOOSH Wrist pain Wrist pain 51 Source undetermined

52 Case 17 Scaphoid fracture Scaphoid fracture Thumb spica splint Thumb spica splint Urgent Hand referral Urgent Hand referral 52

53 Case 18 Nintendo Wii accident Nintendo Wii accident Thumb pain Thumb pain 53 Source undetermined

54 Case 18 Gamekeeper's thumb Gamekeeper's thumb Thumb spica Thumb spica Urgent Hand referral Urgent Hand referral 54

55 Case 19 Barfight Barfight Hand pain Hand pain 55 Source undetermined

56 Case 19 Spiral fracture of second metacarpal Spiral fracture of second metacarpal Splint, referral Splint, referral 56

57 Case 20 MVC MVC Hand pain Hand pain Lateral? Lateral? 57 Source undetermined

58 Case 20 Lateral: Lateral: 58 Source undetermined

59 Case 20 Dislocation of MCC joints 3-5 Dislocation of MCC joints 3-5 Hand consultation, reduction Hand consultation, reduction 59

60 Case 21 Punched a bouncer Punched a bouncer Hand pain Hand pain 60 Source undetermined

61 Case 22 5 th MC body fracture 5 th MC body fracture Reduction? Reduction? Splint Splint 61

62 Case 23 Fall on supinated hand Fall on supinated hand Wrist pain Wrist pain 62 Source undetermined

63 Case 23 Smith's fracture (aka reversed Colles) Smith's fracture (aka reversed Colles) Distal radius Distal radius Impaction and volar displacement Impaction and volar displacement Reduction, splint Reduction, splint 63

64 Case 24 FOOSH FOOSH Wrist pain Wrist pain Lateral? Lateral? 64 Source undetermined

65 Case 24 Lateral: Lateral: 65 Source undetermined

66 Case 24 Peri-lunate dislocation Peri-lunate dislocation Emergent Hand consultation Emergent Hand consultation 66

67 Case 25 FOOSH FOOSH Wrist pain Wrist pain Lateral? Lateral? 67 Source undetermined

68 Case 25 Lateral: Lateral: 68 Source undetermined

69 Case 25 Triquetral dorsal chip fracture Triquetral dorsal chip fracture Splint Splint Urgent Hand referral Urgent Hand referral 69

70 Case 26 FOOSH FOOSH Wrist pain Wrist pain 70 Source undetermined

71 Case 26 Scaphoid fracture Scaphoid fracture Thumb spica splint Thumb spica splint Urgent Hand referral Urgent Hand referral 71


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