Wrist radiograph (summary approach)

Last revised by Craig Hacking on 2 Apr 2018
This is a basic article for medical students and other non-radiologists

Wrist radiographs are commonly used for the assessment of the wrist following trauma. 

Summary approach

  • alignment
    • AP
      • distal radius and ulna have smooth joint surface
      • carpal arcs are smooth
      • carpal bones do not overlap
        • apart from pisiform and trapezium
      • metacarpals do not overlap and distal carpal row
    • lateral
      • radius and ulna overlap
      • radius in line with lunate and capitate
  • bones
    • check all the bones, but pay particular attention to
      • distal radius
      • distal ulna
        • look specifically for an ulnar styloid fracture/avulsion
      • scaphoid
        • scaphoid fracture is the commonest carpal fracture
        • may be challenging to see on standard views
  • cortex
    • trace around the cortex of the bones
      • distal radius and ulna
      • all the carpal bones
      • proximal metacarpals

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Cases and figures

  • AP alignment
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  • Trace the carpal arcs
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  • Review carpometacarpal joint spaces
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  • Lateral alignment
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  • Check radial and ulnar cortex
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  • Cortex check
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