1 Project: Ghana Emergency Medicine Collaborative Document Title: Radiology: X-rays of the Hand and...

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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

Carpal BonesCarpal Bones

66Source undetermined

Normal Wrist PANormal Wrist PA

77

Source undetermined

Normal Wrist LateralNormal Wrist Lateral


Normal Hand PANormal Hand PA


Normal Hand LateralNormal Hand Lateral


Case 1Case 1

HyperextensionHyperextension Tender and Tender and

swollen thumbswollen thumb


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

1414Source undetermined Source undetermined

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 FOOSH, pain in wristFOOSH, pain in wrist

1616Source undetermined Source undetermined

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

FOOSHFOOSH Pain in wristPain in wrist

1818

Case 4Case 4


Source undetermined

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

SkierSkier Tender and swollen Tender and swollen

thumbthumb


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 5Case 5

2424

Source undetermined

3-Point Products, 3pointproducts.com

Case 6Case 6

Punched a wallPunched a wall Wrist painWrist pain


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


Case 7Case 7

FOOSHFOOSH Pain and Pain and

tenderness to tenderness to base of thumb base of thumb and radial wristand radial wrist


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 7Case 7


Case 8Case 8

Assaulted with Assaulted with batbat

Wrist painWrist pain

3030

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


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

3434

Source undetermined Source undetermined

Case 9Case 9

Scapholunate Advance CollapseScapholunate Advance Collapse

3535

Source undetermined

Source undetermined

Case 10Case 10

Punched a wallPunched a wall Hand painHand pain


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

FOOSHFOOSH Dorsal wrist Dorsal wrist

painpain


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


Case 13Case 13

Rolando FractureRolando Fracture AKA double-BennettAKA double-Bennett

Splint, Hand referralSplint, Hand referral Will need ORWill need OR


Case 14Case 14

Tried to Tried to catch catch falling wine falling wine glassglass


Case 14Case 14

Hand foreign bodyHand foreign body Significant litigationSignificant litigation

4646

Case 15Case 15

Nightstick injuryNightstick injury


Case 15Case 15

Chauffeur fractureChauffeur fracture Splint, routine Hand referralSplint, routine Hand referral

4848

Case 16Case 16

Punched a wallPunched a wall Wrist painWrist pain


Case 16Case 16

Die-punch/Lunate load fractureDie-punch/Lunate load fracture Splint, urgent Hand referralSplint, urgent Hand referral

5050

Case 17Case 17

FOOSHFOOSH Wrist painWrist pain

5151

Source undetermined

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


Case 18Case 18

Gamekeeper's thumbGamekeeper's thumb Thumb spicaThumb spica Urgent Hand referralUrgent Hand referral

5454

Case 19Case 19

BarfightBarfight Hand painHand pain


Case 19Case 19

Spiral fracture of second metacarpalSpiral fracture of second metacarpal Splint, referralSplint, referral

5656

Case 20Case 20

MVCMVC Hand Hand

painpain Lateral?Lateral?


Case 20Case 20

Lateral:Lateral:


Case 20Case 20

Dislocation of MCC joints 3-5Dislocation of MCC joints 3-5 Hand consultation, reductionHand consultation, reduction

5959

Case 21Case 21

Punched a Punched a bouncerbouncer

Hand painHand pain


Case 22Case 22

55thth MC body fracture MC body fracture Reduction?Reduction? SplintSplint

6161

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

FOOSHFOOSH Wrist painWrist pain Lateral?Lateral?


Case 24Case 24

Lateral:Lateral:


Case 24Case 24

Peri-lunate dislocationPeri-lunate dislocation Emergent Hand consultationEmergent Hand consultation

6666

Case 25Case 25

FOOSHFOOSH Wrist painWrist pain Lateral?Lateral?


Case 25Case 25

Lateral:Lateral:


Case 25Case 25

Triquetral dorsal chip fractureTriquetral dorsal chip fracture SplintSplint Urgent Hand referralUrgent Hand referral

6969

Case 26Case 26

FOOSHFOOSH Wrist painWrist pain


Case 26Case 26

Scaphoid fractureScaphoid fracture Thumb spica splintThumb spica splint Urgent Hand referralUrgent Hand referral

7171

1 Project: Ghana Emergency Medicine Collaborative Document Title: Radiology: X-rays of the Hand and...

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