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Six patients with “negative” wrist radiographs after spraining their wrists (Figures 1, 2, 3, 4, 5, and 6).

They had all fallen on their outstretched hands.

PA (A), lateral (B) and pronation oblique views (C) are shown for each patient (except where noted).

Effective interpretation of wrist radiographs is based on the knowledge of typical injury patterns. Simply looking for cortical breaks or irregularities makes the search for injuries laborious and potentially misleading. This targeted approach to radiograph interpretation focuses on common sites of injury as well as easily missed injuries that can have subtle radiographic findings.

There are two distinct regions of the wrist: the distal radius and the carpals. Distal radius fractures are 10 times more common than carpal fractures. Distal radius fractures are usually obvious on the lateral view. On the PA and pronation oblique views, a distal radius fracture appears as an area of trabecular disruption or impaction. If a fracture is not clearly seen, obliteration or outward bowing of the pronator quadratus fat stripe on the lateral view can be a clue to the presence of a fracture (see Figure 16).

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