Pediatric wrist (oblique view)

The oblique wrist view for pediatrics is one of three views in order to examine the carpal bones, distal radioulnar joint and metacarpals. 

Indications

This projection is useful for diagnosing subtle wrist fractures and the location of the fracture; particularly in adults. However, the oblique view may not always be performed in pediatric imaging as the information it provides on top of the PA and lateral views may not justify the radiation dose given to the child.

Patient position

• patient is either seated alongside the table or supine with arm outstretched
• the affected wrist is placed with palm on the image receptor
• the wrist and elbow should ideally be at shoulder height to demonstrate the radius and ulna correctly

Technical factors

• posteroanterior projection
• centering point
  • midcarpal region
• collimation
  • laterally to the skin margins
  • include the metacarpals superiorly
  • include the distal third of the radius and ulna inferiorly
• orientation
  • portrait
• detector size
  • 18 cm x 24 cm
• exposure ¹
  • 40-52 kVp
  • 2-3 mAs
• SID
  • 100 cm
• grid
  • no

Image technical evaluation

There is slight superimposition of the ulna head and distal radius. The 3rd to 5th metacarpals are also slightly superimposed ².

Practical points

Preparing the room beforehand (setting up the detector, exposure and preparing lead gowns) is important as pediatric patients may not remain still when their affected wrist is moved onto the detector. 

Immobilization techniques

It is important for the radiograph to be free from motion artifact and rotation to avoid repeated x-rays.

• it may be necessary for the parent or radiographer to hold the patient in position
• ideally the parent should be in the child's direct line of sight
• techniques will vary based on the department
• distraction techniques can be utilized to avoid scattered radiation to parents and staff ³