Orthopaedic Clinic Wrist Radiography

Introduction

There are significant differences in radiography provided in an acute setting to a non-acute setting. In large hospitals, most of the acute orthopaedic radiography will occur in the X-ray rooms which service the Emergency Department. Patients who have orthopaedic injuries requiring follow-up will be seen at orthopaedic clinic and they are usually referred for follow-up radiography of their injury. This page considers wrist radiography techniques that are more commonly employed in follow-up orthopaedic examinations.

Why Follow-up Treated Orthopaedic Injuries?

The simple answer to this question is that there can be a variety of unexpected outcomes including non-union and changes in fracture alignment. A patient with a healed fracture can have immobilisation/support devices removed.

Case 1

This 14 year old boy presented to the Emergency Department after falling onto an outstretched hand. He had a painful and swollen wrist and was referred for right wrist radiography.
There is a fracture of the distal radius which appears undisplaced in this view. The fractured distal radius is demonstrated on the lateral view with minor dorsal angulation.

The patient received a fibreglass plaster and arrangements were made for the patient to return to orthopaedic clinic in 2 weeks to assess the healing of the fracture.

Mixed views of the forearm were performed at follow-up. The radiographer had little choice given that the forearm was in this position when the fibreglass cast was applied. The distal radius fracture is demonstrated with minimal displacement. This position demonstrates the wrist in lateral position and the elbow in AP/oblique position. The distal radius shows considerable displacement and angulation requiring surgical correction.

Comment
Isolated fractures of the distal radius tend to displace late and get stuck <a class="external" href="http://www.orthospot.com.au/papers.orthospot.com.au/fracupl_files/frame.htm" rel="nofollow" target="_blank">(http://www.orthospot.com.au/papers.orthospot.com.au/fracupl_files/frame.htm)</a>. This plaster shows a lack of mould points which may have precipitated the angular displacement of the distal radius fracture.

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There is a fracture of the distal radius which appears undisplaced in this view.	The fractured distal radius is demonstrated on the lateral view with minor dorsal angulation.


Mixed views of the forearm were performed at follow-up. The radiographer had little choice given that the forearm was in this position when the fibreglass cast was applied. The distal radius fracture is demonstrated with minimal displacement.	This position demonstrates the wrist in lateral position and the elbow in AP/oblique position. The distal radius shows considerable displacement and angulation requiring surgical correction.