![]() The intercarpal joint spaces should be uniform and <2 mm wide. Wrist-AP view (see Figure 2.1a )Wrist-AP view (see Figure 2.1a ) The carpometacarpal articulations in particular, where some degree of overlap is unavoidable, should be carefully scrutinised. On AP views, overlap of joint margins may be the only indication of subluxation/dislocation. Alignment should always be assessed on at least two views. Handīony surfaces should be congruent along each ray from the metacarpals to distal phalanges. ![]() In alignment we look at bones and their relationship to each other. MRI is rarely indicated acutely, although some centres are doing MRIs on patient’s with anatomical snuff box tenderness who have normal plain X rays (XRs) to exclude scaphoid fractures. On a true lateral wrist view, the palmar surface of the pisiform bone should overly between the palmar surfaces of the distal scaphoid pole and the capitate head.ĬT is typically reserved for suspected fractures with negative initial and follow-up radiographs or for preoperative planning in cases with significant comminution and intra-articular extension. Radial inclination to the ulna is assessed on the PA view and should be 20–25°.įigure 2.2 Scaphoid coned PA view in ulnar deviation allows for visualisation of the full length of the scaphoid. The radial styloid is distal to the ulnar styloid. The radiocarpal joint has a 4–15° volar tilt and the hand is usually held in slight flexion and ulnar deviation. These bones are held together by a complex arrangement of strong ligaments. ![]() The distal row is more rigid and stable than the proximal. The proximal row (scaphoid, lunate, triquetrum and pisiform) articulates wth the radius and ulna and the distal row (trapezium, trapezoid, capitate and hamate) articulates with the bases of the metacarpals. The wrist ( Figure 2.1a–c, e and f) consists of eight carpal bones arranged in two rows. Table 2.1 Age as a predictor of distal radial fractures following FOOSH. Each finger has two flexor tendons on the volar (palmar) surface and an extensor tendon complex on the dorsal surface. The joint capsule at the MCP and IP joints also demonstrate on the volar aspect areas of dense fibrous thickening, known as the volar plate, which provide further strength. At each metacarpophalangeal (MCP) joint and interphalangeal (IP) joint, lateral stability is provided by the collateral ligaments. ![]() The thumb has a metacarpal and proximal and distal phalanges. Anatomy HandĮach ray, apart from the thumb, consists of a metacarpal and proximal, middle and distal phalanges. Computed tomography (CT) and magnetic resonance imaging (MRI) are developing increasing roles, particularly as their availability increases. Plain radiographs are the mainstay of imaging. The goal of treatment is rapid restoration of function with attention given to the prevention of chronic disability. Age alone also can accurately predict likely fracture pattern ( Table 2.1).Ĭlinical exam is usually accurate in this scenario and strong clinical suspicion for fracture can often direct close radiologic evaluation for subtle abnormalities. Mechanism of injury in these patients can accurately predict injury pattern. Most injuries to the wrist occur following a fall onto an outstretched hand (FOOSH). ![]() The hand is the most active part of the body, is the least well protected and thus is often injured. Injuries to the hand and wrist are very common, accounting for 20% of acute fractures presenting to emergency departments. ![]()
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