Download pdf - GEMC: Radiology: X-rays of the Hand and Wrist: Resident Training

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Project: Ghana Emergency Medicine Collaborative Document Title: Radiology: X-rays of the Hand and Wrist Author(s): Christian Jacobus MD, Maine Medical Center, 2007 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/

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Radiology: X-rays of the Hand and Wrist

Christian Jacobus, MD April 11, 2007

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Overview

n  Brief review of normal radiographic anatomy

n  Cases n  I give you mechanism, complaint, and X-ray n  You give me diagnosis, treatment, and

eponym

n  Shameless unrelated entertainment

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I Will not Cover…

n  Phalanx fractures n  Soft tissue injuries (except that can be

detected on plain film) n  Cross sectional imaging

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Carpal Bones

6 Source undetermined

Normal Wrist PA

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Source undetermined

Normal Wrist Lateral


Normal Hand PA


Normal Hand Lateral


Case 1

n  Hyperextension n  Tender and swollen

thumb


Case 1

n  Bennett Fracture n  Fx-Disloc of base of

thumb MC n  APL tendon

n  Splint, Hand referral n  Will need OR

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Source undetermined

Case 2

n  FOOSH, wrist pain n  Deformity to dorsal wrist n  Decreased sensation to volar palm

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Case 2

14 Source undetermined Source undetermined

Case 2

n  Peri-lunate dislocation n  Lunate remains articulated with radius n  Distal carpal bones translate dorsally n  Emergent Hand consult

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Case 3 n  FOOSH, pain in wrist

16 Source undetermined Source undetermined

Case 3

n  Lunate dislocation n  Disruption of all lunate ligaments n  Emergent Hand consultation

17 E-Hand.com, eatonhand.com

Case 4

n  FOOSH n  Pain in wrist

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Case 4


Source undetermined

Case 4

n  Colles fracture

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Sletuffe, Wikimedia Commons Abigor, Wikimedia Commons

Case 4

n  Colles fracture n  Distal metaphysis of the radius n  Dorsal displacement and shortening

n  Silver fork deformity

n  Reduction, splinting n  Be alert for elbow and scaphoid injuries

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Case 5

n  Skier n  Tender and swollen

thumb


Case 5

n  Gamekeeper’s Thumb/Skier’s Thumb/ Breakdancer’s Thumb n  Disruption of the UCL of the thumb MCP n  Only visible on plain film when avulsion fx is

present

n  Splint, Hand Referral n  Will likely need OR

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Case 5

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Source undetermined

3-Point Products, 3pointproducts.com

Case 6

n  Punched a wall n  Wrist pain


Case 6

n  Die-punch or lunate load fracture

n  Axial force along hand n  Splint, urgent referral


Case 7

n  FOOSH n  Pain and

tenderness to base of thumb and radial wrist


Case 7

n  Scapho-lunate dissociation n  Terry Thomas/David Letterman sign

n  Scapho-lunate space >4mm

n  Splint n  Urgent f/u

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Source undetermined

Case 7


Case 8

n  Assaulted with bat n  Wrist pain

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Source undetermined

Case 8

n  Chauffeur's/Backfire/Hutchinson Fracture n  Direct blow to distal edge of radius n  Often scapholunate dissociation n  Splint, urgent referral

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Case 9

n  13 yo, FOOSH n  Pain to radial wrist


Case 9

n  Scaphoid fracture n  Frequently missed n  High litigation n  Splint, urgent hand

33 Houston Methodist Orthopedics & Sport Medicine, methodistorthopedics.com

Case 9

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Source undetermined Source undetermined

Case 9

n  Scapholunate Advance Collapse

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Source undetermined Source undetermined

Case 10

n  Punched a wall n  Hand pain


Case 10

n  Boxer's fracture n  Splint n  Hand referral

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Source undetermined

Case 10

n  Displacement in metacarpal fractures n  Reduce

n  > 10° in 2 and 3 n  > 30° in 4 and 5 n  Any rotation

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Case 11

n  FOOSH n  Dorsal wrist pain


Case 11

n  Triquetrum fracture n  Most dorsal bone on lateral n  Dorsal fracture most common n  Splint, referral

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Case 12

n  14 yo boy n  Basketball injury n  Wrist pain

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Source undetermined

Case 12

n  Normal adolescent wrist n  Partially closed physes n  Splint

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Case 13

n  Thumb hyper-extension

n  Tender and swollen thumb


Case 13

n  Rolando Fracture n  AKA double-Bennett

n  Splint, Hand referral n  Will need OR


Case 14

n  Tried to catch falling wine glass


Case 14

n  Hand foreign body n  Significant litigation

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Case 15

n  Nightstick injury


Case 15

n  Chauffeur fracture n  Splint, routine Hand referral

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Case 16

n  Punched a wall n  Wrist pain


Case 16

n  Die-punch/Lunate load fracture n  Splint, urgent Hand referral

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Case 17

n  FOOSH n  Wrist pain

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Source undetermined

Case 17

n  Scaphoid fracture n  Thumb spica splint n  Urgent Hand referral

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Case 18

n  Nintendo Wii accident n  Thumb pain


Case 18

n  Gamekeeper's thumb n  Thumb spica n  Urgent Hand referral

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Case 19

n  Barfight n  Hand pain


Case 19

n  Spiral fracture of second metacarpal n  Splint, referral

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Case 20

n  MVC n  Hand pain n  Lateral?


Case 20

n  Lateral:


Case 20

n  Dislocation of MCC joints 3-5 n  Hand consultation, reduction

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Case 21

n  Punched a bouncer

n  Hand pain


Case 22

n  5th MC body fracture n  Reduction? n  Splint

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Case 23

n  Fall on supinated hand

n  Wrist pain

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Source undetermined

Case 23

n  Smith's fracture (aka reversed Colles) n  Distal radius n  Impaction and volar displacement n  Reduction, splint

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Case 24

n  FOOSH n  Wrist pain n  Lateral?


Case 24

n  Lateral:


Case 24

n  Peri-lunate dislocation n  Emergent Hand consultation

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Case 25

n  FOOSH n  Wrist pain n  Lateral?


Case 25

n  Lateral:


Case 25

n  Triquetral dorsal chip fracture n  Splint n  Urgent Hand referral

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Case 26

n  FOOSH n  Wrist pain


Case 26

n  Scaphoid fracture n  Thumb spica splint n  Urgent Hand referral

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