MOSBY – MERRILLS & BONTAGER Upper Extremity WRIST RTEC 123 # 1B LECTURE Contributions by: MOSBY – MERRILLS & BONTAGER XRAY2000.CO.UK rev 10/10/11

ANATOMY REVIEW WRIST

S L T P C H

TEST YOURSELF

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POSITIONING Use a FULL SHIELD PROTECT THE BREAST & THYROID HAVE PATIENT TURN THEIR HEAD

WRIST (5) PA OBLIQUE (MEDIAL)- PA OBLIQUE LATERAL OBLIQUE (LATERAL) AP OBLIQUE ULNAR DEVIATION (SCAPHOID “view”)

PA WRIST Note incorrect position of patient ! ↑

PA vs AP WRIST

PA OBLIQUE WRIST

PA OBLIQUE

PA OBLIQUE

AP OBLIQUE WRIST

Alternate positioning for obliques

THESE ARE THE SAME POSITION ON THE IMAGE PA OBLIQ / AP OBLIQ : LAT ROTATION

Which Oblique & What is seen?

OBLIQUE WRIST PA OBL (LAT ROT) / AP OBLIQ (MED ROT)

PA Oblique / AP Oblique

“true” Lateral

MOST COMMONLY FX CARPAL BONE

SCAPHOID

When the hand is turned toward the ulnar side, it is termed: A. adduction B. abduction C. ulnar deviation D. radial deviation

When the hand is turned toward the ulnar side, it is termed: A. adduction B. abduction C. ulnar deviation D. radial deviation

ADDITONAL VIEWS - WRIST CARPAL CANAL LECTURE ONLY – NOT FOR LAB PRACTICE

CRITIQUE WRIST Digital “issues”

43

PATHOLOGY FOR UPPER EXTREMITY 1 SEE CHART PG ______ Avulsion fx Bone cyst Bursitis fractures Joint effusion Osteoporosis Rheumatoid Arthritis

AP/LAT wrist showing complete dislocation of the lunate

Fracture type?

Fracture type? What else should be done?

Problem/ Path?

greenstick

Torus or Buckle Impacted fracture with bulging of the periosteum. 50

This fracture is most common in children between the ages of 5 and 11 This fracture is most common in children between the ages of 5 and 11. Typically, the child reports having fallen onto his or her outstretched hand. 51

impacted 52

scaphoid If the fracture is not recognized early, it may not heal properly. This can lead to problems later. 53

Scaphoid fx new 3 wks later

SCAPHOID FX

57

Colles’ Fracture Extension-Compression Fracture of Distal Radius FX WITH POSTERIOR DISPLACEMENT

Colles' fracture of the distal radius and ulnar styloid with posterior displacement (of the hand)

Colle's fractures usually occur when an adult falls on a hyperextended, outstretched hand. There is frequently an associated fracture of the ulnar styloid. Smith's fracture is caused by a fall on a hyperflexed, outstretched hand. It is sometimes referred to as a "reverse Colle's fracture."

Smith's fracture of the distal radius and ulnar styloid with anterior displacement.

SMITH’S FX Flexion-Compression FX WITH ANTERIOR DISPLACEMENT

Smith’s FX

BARTON’S fx FX/DISLOCATION OF POSTERIOR LIP OF DISTAL RADIUS unstable intra-articular fracture of the dorsal lip of the radius with dorsal subluxation of the carpus along with the dorsal radius fragment

Colles vs Barton’s

Colles' fracture? 70

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QUESTIONS ? OPEN LABS SIGN UP ? Days TBA NOTE: NO OPEN LABS BEFORE I DO DEMONSTRATIONS