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A 24-year-old man presented to the ED with pain after hitting his wrist on a table.

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Five weeks earlier, he had fallen from his bicycle onto his outstretched hand injuring his wrist. He was examined at another hospital where radiographs were obtained and a wrist injury was diagnosed. He was immobilized in a splint and was told to follow-up with a hand surgeon, but he did not do so. The patient continued to have pain and limited mobility of his wrist and so following this minor injury, he decided to have it evaluated again.

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On examination, there was tenderness of the volar surface of the wrist. Flexion of the wrist was limited to 10°. He also had limitation of flexion of his middle and ring fingers. Sensation of the hand was intact. Abduction and adduction of the fingers were normal.

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  • There are four injuries in this patient.
  • How are wrist radiographs systematically interpreted?

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Wrist injuries can be difficult to diagnose because of their complex anatomy and frequently subtle radiographic manifestations. This case illustrates the importance of a systematic approach to radiograph interpretation in which each of the radiographic signs of a fracture are sought: cortical interruption or deformity due to a fracture, alterations in skeletal alignment, and changes in adjacent soft tissues. The ABCS mnemonic works well for wrist radiographs—A is for adequacy and alignment,B is for bones (fracture lines), C is for cartilage (joint spaces), and S is for soft tissue changes (Table 1).

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Table Graphic Jump Location
Table 1 Systematic Analysis of Wrist Radiographs—the ABCs There Are Two Regions of Injury: The Carpals and the Distal Radius
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Efficient and accurate radiograph interpretation also entails a targeted approach, looking for commoninjury patterns and injuries that can easily be missed. One of the common wrist injury patterns is illustrated in this case.

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The three standard radiographs of the wrist are the PA, ...

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