EMRad: Radiologic Approach to the Traumatic Wrist

This is EMRad, a series aimed at providing “just in time” approaches to commonly ordered radiology studies in the emergency department. When applicable, it will provide pertinent measurements specific to management, and offer a framework for when to get an additional view, if appropriate. Last post, we focused on the elbow. Now: the wrist. Learning Objectives Interpret traumatic wrist x-rays using a standard approach. Identify clinical scenarios in which an additional view might improve pathology diagnosis Why the wrist matters and the radiology rule of 2’s The Wrist 25% of all sports-related injuries involve the hand or wrist.​1​ Approximately 1.5% of all ED visits involve the hand and forearm.​2​ Missed wrist injuries can be highly morbid. Missed wrist injuries are a common area of litigation. Before we begin: Make sure to employ the rule of 2’s​3​ 2 views: One view is never enough. 2 abnormalities: If you see one abnormality, look for another. 2 joints: Image above and below (especially for forearm and leg). 2 sides: If unsure regarding a potential pathologic finding, compared to another side. 2 occasions: Always compare with old x-rays if available. 2 visits: Bring the patient back for repeat films. An approach to the traumatic wrist x-ray Adequacy/Alignment Bones Distal radius Distal ulna Carpal bones Carpal/metacarpal alignment  Perilunate/lunate dislocation Gilula’s Lines Carpometacarpal dislocation  Distal radioulnar joint (DRUJ) subluxation/dislocation Consider an additional view 1. Adequacy PA View Check for rotation. There should be no overlap of radius and ulna. The view should include distal radius and ulna. Lateral View Check for rotation. There should be a perfect overlap of radius and ulna. Identify the distal radius, lunate and capitate. They should make a straight line. 2. Bones Distal radius and ulnar … Continue reading EMRad: Radiologic Approach to the Traumatic Wrist