Year Book: Roentgenographic Examination of the Wrist: A Systematic Study of
the Normal, Lax and Injured Wrist. Part 1: The Standard and Positional Views. Schernberg, F. Abstract/Commentary:|1992 Year Book of Hand Surgery. Article 9-6.|Original Article:|J Hand Surg. 1990. 15-B. pp 210-219.. Background.--Injuries of the carpus have hitherto been difficult to appraise because of the large numbers of bones and joints potentially involved. Analysis of x-ray studies was undertaken to standardize a methodology for the analysis of x-ray studies of the bones and joints of the wrist in standard and positional views and to establish criteria for normalcy in such studies. Methods.--The x-ray studies of 100 normal wrists; 15 lax wrists without a history of trauma or rheumatoid or arthritic disease; and 80 injured wrists were examined. The posterior-anterior (PA) view, with the fingers extended and the thumb abducted, was the most stable frontal view. Radiographs were made with radial, neutral, and ulnar deviations; standard lateral views also were made. The changing frontal appearances of an isolated triquetrum under pronation, supination, flexion, and extension were used as references to define normal scapho-luno-triquetral relations on frontal views in different deviations. Results.--The normal appearance of the proximal carpal row in the 3 positions is illustrated in Figure 9-5. In the lax wrist, the joint surfaces are normal; abnormality is evidenced only by the length or structure of the ligaments, and laxity generally is disclosed only in positional or stress views. Of 80 wrist injuries studied under stress, 53 showed abnormal standard views and 27 appeared normal. There was 1 wrist with midcarpal instability, with an audible click on ulnar deviation of the wrist that could be suppressed by dorsal stress on the ulnar part of the wrist over the pisiform. Static PA and lateral views of this wrist showed a loss of the smooth reciprocal rotation between the proximal and distal carpal rows in that the proximal row switched suddenly from flexion to extension when the click occurred. Conclusions.--The frontal view, with the hand in neutral position, permits a step-wise, systematic analysis of the carpus; normality is defined at the proximal row of carpal bones, the radiocarpal joint, and the midcarpal joint. Standard frontal and lateral views combined with oblique views of the wrist in semipronation or semisupination are most appropriate for evaluation of carpal fractures. Ambiguous results must be clarified by stress views.
Original Text by Clifford R. Wheeless, III, MD.
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