The scaphoid series is comprised of posteroanterior, oblique, lateral and angled posteroanterior projections. The series examines the carpal bones focussed mainly on the scaphoid. It also examines the radiocarpal and distal radioulnar joints along with the distal radius and ulna. Scaphoid fractures are often a result of FOOSH injuries and have a bad prognosis if missed (risk of avascular necrosis of proximal aspect in scaphoid waist fracture). Often if a scaphoid fracture is suspected and not seen on plain film, a follow-up will be performed in 7-10 days ¹. 

Indications

Scaphoid x-rays are indicated for a variety of settings including:

• wrist trauma

• bony tenderness at the anatomical snuffbox

• suspected fracture

• obvious deformity

• non-traumatic wrist pain

Projections

Standard projections

• PA view

  • ulnar deviation to remove the scaphoid from the radius and present its axis longitudinally

  • the best view to inspect the joint spaces of the carpal bones and the distal radioulnar joint

• PA view angled

  • ulnar deviation to remove the scaphoid from the radius and present its axis longitudinally

  • tube angulation to present the scaphoid en face

• oblique view

  • external oblique projection 

• lateral view 

  • projection 90° to the PA view

  • demonstrates multiple carpal bones overlapping

  • the essential view to assessing the alignment of the radius, lunate, and capitate in the setting of a suspected dislocation

Modified trauma projections

• horizontal beam lateral view

  • modified lateral projection that requires little to no patient movement

  • produces a diagnostic lateral projection without risking patient pain

Additional projections

• clenched fist view

  • used for suspected scapholunate dissociation