The Wrist

Fracture prevalence | Normal anatomy PA| Normal anatomy lateral
Colles/Smiths | Radial styloid | Paediatric
Scaphoid
| Triquetrum | Hamate | Lunate | Pisiform | Capitate| Trapezium| Trapezoid
Carpal dislocations | Zone of Vulnerability | Carpal Instability | Galeazzi

(click on images to enlarge)
Fracture prevalence
Normal anatomy - PA film

These three lines should remain unbroken:

normal wrist   normal wrist

epiphyseal spur
Normal anatomy - Lateral film
normal wrist   normal wrist
Colles / Smiths fracture
Radial Styloid Fracture
  • Fractures are common due to blunt trauma directly to the radial styloid process. Fractures are oblique, intra-articular and are usually minimally displaced:

    radial styloid
Paediatric fractures

Salter-Harris I   Salter-Harris II
Scaphoid

Scaphoid - 1st visit   Scaphoid - 2nd visit   Scaphoid - 3rd visit

# distal pole scaphoid
AVN scaphoid
Triquetrum

# triquetrum
Hamate

# hamate, # 4th metacarpal

Lunate
  • Fractures are rare. Lunate dislocations may occur following high impact trauma. A sclerotic lunate is sometimes seen. This is due to Keinbock's disease which refers to osteochondritis of the lunate due to avascular necrosis (decreased blood supply). The lunate becomes denser radiographically, fragments and collapses:

    AVN lunate
Pisiform
  • Fractures very occasionally seen due to direct trauma to the antero-medial aspect of the carpus:

    # pisiform
Capitate
  • Isolated fractures are rare, but as part of complex lunate/perilunate fracture-dislocations, a transverse fracture of the capitate may be seen.
Trapezium
  • Fractures are rare. The 1st carpo-metacarpal joint is a very common site for arthritic changes.

    fractured trapezium, fractured triquetral
Trapezoid
  • Fractures are rare.

Carpal Dislocations
lunate dislocation   lunate dislocation
perilunate dislocation    perilunate dislocation
midcarpal dislocation  midcarpal dislocation
Zone of vulnerability

zone of vulnerability
Carpal instability

carpal instability
  • A 'clenched fist' view is sometimes helpful to demonstrate the widening at the joint:
clenched fist view
Galeazzi fracture-dislocation
galeazzi #-dislocation   galeazzi


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