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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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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, lateral, and pronation ...