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