Test yourself: X-wrist
Case Study 1.
A 55-year-old man has to swerve on his bicycle for a pedestrian and falls. He hits the pavement with an outstretched arm.
The left wrist is very painful. A wrist X-ray is made at the Emergency Assistance (fig. 1).
Figure 1. PA image (a) and lateral image (b) of the left wrist.
Several lucencies can be seen in the distal radius, consistent with fracture lines. The fracture extends into the radiocarpal joint. There is no clear articular step-off of the radiocarpal joint.
There is no disruption of the DRU joint.
The lateral image shows palmar dislocation of the distal radius.
Intra-articular distal radial fracture with palmar angulation (Smith's fracture).
♦ Figure 2. Answer: Intra-articular distal radial fracture with palmar angulation.
Case Study 2.
A 10-year-old boy stops a ball with his left wrist during soccer. The wrist is slightly swollen and painful on movement.
A wrist X-ray is made (fig. 2).
Figure 2. PA image (a) and lateral image (b) of the left wrist.
The lateral image shows a discrete buckle of the distal radius. There is no cortical interruption.
The abnormality cannot be seen on the PA view.
Torus fracture (= buckle fracture) of the distal radius.
♦ Figure 2. Answer: Torus fracture of distal radius.
Case Study 3.
A 27-year-old woman is suddenly knocked over by a dog. She falls on hard ground with an outstretched hand. Examination reveals pressure pain over the anatomical snuffbox.
A scaphoid series is also made (fig.3/4).
Figure 3. Scaphoid series: PA in ulnar deviation and lateral image.
Figure 4. Scaphoid series: fist image and 60° oblique image in ulnar deviation.
The scaphoid is intact and in the normal position.
The PA image shows a discrete fracture line in the radial styloid process (to a lesser degree visible on the fist image also).
There is no dislocation.
Intra-articular distal radial fracture (chauffeur fracture).
♦ Figure 4. Answer: Intra-articular distal radial fracture (chauffeur fracture).