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236 237 238<div class='row mb-3'> 239<div class='col-7'> 240<div class="mt-3"> 241<h3>The Wrist</h3> 242</div> 243</div> 244<div class='col text-right d-none d-md-block'> 245 246<!-- Sharingbutton Facebook --> 247<a class="resp-sharing-button__link" href="https://facebook.com/sharer/sharer.php?u=https%3A%2F%2Fwww.imageinterpretation.co.uk" target="_blank" aria-label=""> 248 <div class="resp-sharing-button resp-sharing-button--facebook resp-sharing-button--small"><div aria-hidden="true" class="resp-sharing-button__icon resp-sharing-button__icon--solid"> 249 <svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 24 24"><path d="M18.77 7.46H14.5v-1.9c0-.9.6-1.1 1-1.1h3V.5h-4.33C10.24.5 9.5 3.44 9.5 5.32v2.15h-3v4h3v12h5v-12h3.85l.42-4z"/></svg> 250 </div> 251 </div> 252</a> 253 254 255<!-- Sharingbutton Tumblr --> 256<a class="resp-sharing-button__link" href="https://www.tumblr.com/widgets/share/tool?posttype=link&title=Norwich%20Image%20Interpretation%20Course&caption=Norwich%20Image%20Interpretation%20Course&content=https%3A%2F%2Fwww.imageinterpretation.co.uk&canonicalUrl=https%3A%2F%2Fwww.imageinterpretation.co.uk&shareSource=tumblr_share_button" target="_blank" aria-label=""> 257 <div class="resp-sharing-button resp-sharing-button--tumblr resp-sharing-button--small"><div aria-hidden="true" class="resp-sharing-button__icon resp-sharing-button__icon--solid"> 258 <svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 24 24"><path d="M13.5.5v5h5v4h-5V15c0 5 3.5 4.4 6 2.8v4.4c-6.7 3.2-12 0-12-4.2V9.5h-3V6.7c1-.3 2.2-.7 3-1.3.5-.5 1-1.2 1.4-2 .3-.7.6-1.7.7-3h3.8z"/></svg> 259 </div> 260 </div> 261</a> 262 263<!-- Sharingbutton E-Mail --> 264<a class="resp-sharing-button__link" href="mailto:?subject=Norwich%20Image%20Interpretation%20Course&body=https%3A%2F%2Fwww.imageinterpretation.co.uk" target="_self" aria-label=""> 265 <div class="resp-sharing-button resp-sharing-button--email resp-sharing-button--small"><div aria-hidden="true" class="resp-sharing-button__icon resp-sharing-button__icon--solid"> 266 <svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 24 24"><path d="M22 4H2C.9 4 0 4.9 0 6v12c0 1.1.9 2 2 2h20c1.1 0 2-.9 2-2V6c0-1.1-.9-2-2-2zM7.25 14.43l-3.5 2c-.08.05-.17.07-.25.07-.17 0-.34-.1-.43-.25-.14-.24-.06-.55.18-.68l3.5-2c.24-.14.55-.06.68.18.14.24.06.55-.18.68zm4.75.07c-.1 0-.2-.03-.27-.08l-8.5-5.5c-.23-.15-.3-.46-.15-.7.15-.22.46-.3.7-.14L12 13.4l8.23-5.32c.23-.15.54-.08.7.15.14.23.07.54-.16.7l-8.5 5.5c-.08.04-.17.07-.27.07zm8.93 1.75c-.1.16-.26.25-.43.25-.08 0-.17-.02-.25-.07l-3.5-2c-.24-.13-.32-.44-.18-.68s.44-.32.68-.18l3.5 2c.24.13.32.44.18.68z"/></svg> 267 </div> 268 </div> 269</a> 270 271<!-- Sharingbutton Pinterest --> 272<a class="resp-sharing-button__link" href="https://pinterest.com/pin/create/button/?url=https%3A%2F%2Fwww.imageinterpretation.co.uk&media=https%3A%2F%2Fwww.imageinterpretation.co.uk&description=Norwich%20Image%20Interpretation%20Course" target="_blank" aria-label=""> 273 <div class="resp-sharing-button resp-sharing-button--pinterest resp-sharing-button--small"><div aria-hidden="true" class="resp-sharing-button__icon resp-sharing-button__icon--solid"> 274 <svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 24 24"><path d="M12.14.5C5.86.5 2.7 5 2.7 8.75c0 2.27.86 4.3 2.7 5.05.3.12.57 0 .66-.33l.27-1.06c.1-.32.06-.44-.2-.73-.52-.62-.86-1.44-.86-2.6 0-3.33 2.5-6.32 6.5-6.32 3.55 0 5.5 2.17 5.5 5.07 0 3.8-1.7 7.02-4.2 7.02-1.37 0-2.4-1.14-2.07-2.54.4-1.68 1.16-3.48 1.16-4.7 0-1.07-.58-1.98-1.78-1.98-1.4 0-2.55 1.47-2.55 3.42 0 1.25.43 2.1.43 2.1l-1.7 7.2c-.5 2.13-.08 4.75-.04 5 .02.17.22.2.3.1.14-.18 1.82-2.26 2.4-4.33.16-.58.93-3.63.93-3.63.45.88 1.8 1.65 3.22 1.65 4.25 0 7.13-3.87 7.13-9.05C20.5 4.15 17.18.5 12.14.5z"/></svg> 275 </div> 276 </div> 277</a> 278</div> 279</div> 280 281 282<h6 class="text-center mt-4 mb-4"> 283<a class="btn btn-outline-primary btn-sm mb-2" href="#prevalence">Fracture prevalence</a> 284<a class="btn btn-outline-primary btn-sm mb-2" href="#normalPA">Normal anatomy PA</a> 285<a class="btn btn-outline-primary btn-sm mb-2" href="#normalLateral">Normal anatomy lateral</a><BR> 286<a class="btn btn-outline-primary btn-sm mb-2" href="#Colles">Colles'/Smith's</a> 287<a class="btn btn-outline-primary btn-sm mb-2" href="#radial_styloid_fracture">Radial styloid</a> 288<a class="btn btn-outline-primary btn-sm mb-2" href="#paediatric">Paediatric</a> 289<a class="btn btn-outline-primary btn-sm mb-2" href="#scaphoid">Scaphoid</a> 290<a class="btn btn-outline-primary btn-sm mb-2" href="#triquetrum">Triquetrum</a> 291<a class="btn btn-outline-primary btn-sm mb-2" href="#hamate">
291Hamate</a> 292<a class="btn btn-outline-primary btn-sm mb-2" href="#lunate">Lunate</a> 293<a class="btn btn-outline-primary btn-sm mb-2" href="#pisiform">Pisiform</a> 294<a class="btn btn-outline-primary btn-sm mb-2" href="#capitate">Capitate</a> 295<a class="btn btn-outline-primary btn-sm mb-2" href="#trapezium">Trapezium</a> 296<a class="btn btn-outline-primary btn-sm mb-2" href="#trapezoid">Trapezoid</a><BR> 297<a class="btn btn-outline-primary btn-sm mb-2" href="#Carpal_dislocations">Carpal dislocations</a> 298<a class="btn btn-outline-primary btn-sm mb-2" href="#zov">Zone of Vulnerability</a> 299<a class="btn btn-outline-primary btn-sm mb-2" href="#carpalInstability">Carpal Instability</a> 300<a class="btn btn-outline-primary btn-sm mb-2" href="#galeazzi">Galeazzi</a> 301<BR><BR> 302(hover over images to zoom, click to enlarge)</h6> 303 304 305<div class="card border-success mb-3" > 306 <div class="card-header">Learning outcomes</div> 307 <div class='card-body text-success'> 308<ul> 309 310 <li>Assess skeletal radiographs using a systematic approach on the DP and lateral</li> 311 <li>Describe carpal anatomy</li> 312 <li>Understand mechanisms of injury and the likely fractures/dislocations which may result </li> 313 <li>Recognise less common fractures to the individual carpal bones</li> 314 <li>Accurately describe carpal dislocations and associated fractures within the zone of vulnerability</li> 315 <li>Understand common eponyms</li> 316 <li>Recognise potential ligament injuries</li> 317 <li>Understand paediatric fractures â torus/greenstick terminology</li> 318 </ul> 319</div> 320</div> 321 322<div class="card border-dark mb-3" > 323 <div class="card-header" id="prevalence">Fracture prevalence</div> 324 <div class="card-body text-dark"> 325 326<p>A fall on the out-stretched hand (FOOSH) tends to result in specific injuries depending on the general age of the patient: 327</p> 328<ul style="list-style-type:none"> 329<li>4-10 years - Torus fracture of the distal radial metaphysis</li> 330<li>11-16 years - Salter-Harris II fracture involving the physeal plate</li> 331<li>17-40 years - Scaphoid fracture</li> 332<li>Over 40 years - Colles'-type fracture</li> 333</ul> 334</div> 335</div> 336 337<div class="card border-dark mb-3" > 338 <div class="card-header" id="normalPA">Normal anatomy - PA radiograph</div> 339 <div class="card-body text-dark"> 340 341<ul> 342<li>Distal radial articular surface tilts 17 degrees towards the ulna.</li> 343<li>Medially the radius articulates with the head of the ulna at the ulnar notch. The head of the ulna is normally up to 2mm shorter than the radius, and either touches or slightly overlaps the radius at the distal radioulnar joint.</li> 344<li>The width of the intercarpal joints is uniform, approximately 2mm.</li> 345<li>Three carpal arcs should be traced: 346<ol> 347<li>along the proximal row of carpal bones; proximal aspect.</li> 348<li>along the proximal row of carpal bones; distal aspect.</li> 349<li>along the capitate and hamate proximally.</li> 350</ol> 351</li> 352<li class="no-bullet"> 353These three lines should remain unbroken:</li> 354</ul> 355 356<div class="text-center mb-4"> 357<a href="images/wrist/normal%20dp.jpg" title="Normal DP wrist" class="MagicZoom"><img class="tn img-thumbnail" alt="Normal DP wrist" src="images/wrist/normal%20dp-1.jpg"></a> 358 359<a href="images/wrist/normal%20graphic%20dp.jpg" title="Normal DP wrist" class="MagicZoom"><img src="images/wrist/normal%20graphic%20dp-1.jpg" alt="Normal DP wrist" class="tn img-thumbnail" ></a> 360</div> 361<ul> 362<li>The distal radial epiphyseal line may remain as a linear density, with a spur-like projection laterally, simulating a fracture due to the break in the cortex. However, this is a normal variant.</li> 363</ul> 364<div class="text-center mb-4"><a href="images/wrist/NORMAL%20WRIST%20-%20EPIPHYSEAL%20SPUR.jpg" title="Epiphyseal spur" class="MagicZoom"><img class="tn img-thumbnail" alt="Epiphyseal spur" src="images/wrist/NORMAL%20WRIST%20-%20EPIPHYSEAL%20SPUR-1.jpg"></a></div> 365</div> 366</div> 367 368<div class="card border-dark mb-3" > 369 <div class="card-header" id="normalLateral">Normal anatomy - Lateral radiograph</div> 370 <div class="card-body text-dark"> 371 372<ul> 373<li>The distal articular surface is angled 10-15 degrees anteriorly. This is useful when identifying subtle fractures at the distal radius with flattening of this angle.</li> 374<li>Articular surfaces of radius, lunate and capitate should be in a straight line and be congruent (parallel). The "apple" (capitate) should sit in the "cup" (lunate), which should sit in the "saucer" (radius):</li> 375</ul> 376<div class="text-center mb-4"><a href="images/wrist/normal%20lat.jpg" title="Normal lateral wrist" class="MagicZoom"><img class="tn img-thumbnail" alt="Normal lateral wrist" src="images/wrist/normal%20lat-1.jpg"></a> 377<a href="images/wrist/normal%20graphic%20lat.jpg" title="Normal lateral wrist" class="MagicZoom"><img src="images/wrist/normal%20graphic%20lat-1.jpg" alt="Normal lateral wrist" class="tn img-thumbnail" ></a></div> 378</div> 379</div> 380 381<div class="card border-dark mb-3" > 382 <div class="card-header" id="Colles">Colles' / Smith's fracture</div> 383 <div class="card-body text-dark"> 384 385<ul> 386<li>Fractures of the distal radius are classified depending on which direction the distal fragment is displaced. If displaced posteriorly, it is referred to as a Colles' fracture. The term "Colles" was originally used to describe a very specific injury, but the term is now used more generally. 387</li> 388</ul> 389<div class="text-center mb-4"><a href="images/wrist/COLLES.jpg" title="Colles' fracture" class="MagicZoom">
389<img src="images/wrist/COLLES-1.jpg" alt="Colles' fracture" class="tn img-thumbnail" ></a> </div> 390<ul> 391<li>If the distal fragment is displaced anteriorly, the fracture is classified as a "Smith's" fracture: 392</li> 393</ul> 394<div class="text-center mb-4"><a href="images/wrist/smiths.jpg" title="Smith's fracture" class="MagicZoom"><img src="images/wrist/smiths-1.jpg" alt="Smith's fracture" class="tn img-thumbnail" ></a></div> 395<ul> 396<li>A Barton's fracture refers to an intra-articular shearing fracture with subluxation at the radio-carpal joint. It is described by the direction of displacement. The volar type is most common: 397</li> 398</ul> 399<div class="text-center mb-4"><a href="images/wrist/bartons.jpg" title="Volar type Barton's - fracture volar rim radius (and ulna) with anterior subluxation radiocarpal joint" class="MagicZoom"><img src="images/wrist/bartons-1.jpg" alt="Volar type Barton's - fracture volar rim radius (and ulna) with anterior subluxation radiocarpal joint" class="tn img-thumbnail" ></a></div> 400<ul> 401<li>If the distal radius fracture is displaced, the attachment of the triangular fibrocartilage tends to result in an avulsion fracture of the ulnar styloid process: 402</li> 403</ul> 404<div class="text-center mb-4"><a href="images/wrist/AVULSION%20ULNAR%20STYLOID.jpg" title="Avulsion fracture of ulnar styloid (and Colles' fracture)" class="MagicZoom"><img src="images/wrist/AVULSION%20ULNAR%20STYLOID-1.jpg" alt="Avulsion fracture of ulnar styloid (and Colles' fracture)" class="tn img-thumbnail" ></a></div> 405</div> 406</div> 407 408<div class="card border-dark mb-3" > 409 <div class="card-header" id="radial_styloid_fracture">Radial Styloid Fracture</div> 410 <div class="card-body text-dark"> 411<ul> 412<li>Fractures are common due to blunt trauma directly to the radial styloid process. Fractures are oblique, intra-articular and are usually minimally displaced: 413</li> 414</ul> 415<div class="text-center mb-4"><a href="images/wrist/RADIAL%20STYLOID.jpg" title="Radial styloid fracture" class="MagicZoom"><img src="images/wrist/RADIAL%20STYLOID-1.jpg" alt="Radial styloid fracture" class="tn img-thumbnail" ></a></div> 416</div> 417</div> 418 419<div class="card border-dark mb-3" > 420 <div class="card-header" id="paediatric">Paediatric fractures</div> 421 <div class="card-body text-dark"> 422 423 424<ul> 425<li>Most common, but often subtle, are torus fractures of the distal radial metaphysis, usually dorsally (due to a FOOSH). The torus fracture will be evident by a buckling of the cortex with little displacement: 426</li> 427</ul> 428<div class="text-center mb-4"><a href="images/wrist/torus.jpg" title="Torus fracture" class="MagicZoom"><img src="images/wrist/torus-1.jpg" alt="Torus fracture" class="tn img-thumbnail" ></a></div> 429<ul> 430<li>Greenstick fractures of the radial and ulnar shaft are demonstrated by a break in one cortex only (incomplete), with displacement/angulation. An increase in the force will result in a complete fracture. 431</li> 432</ul> 433<div class="text-center mb-4"><a href="images/wrist/greenstick.jpg" title="Greenstick fracture" class="MagicZoom"><img src="images/wrist/greenstick-1.jpg" alt="Greenstick fracture" class="tn img-thumbnail" ></a></div> 434<ul> 435<li>Salter-Harris fractures involving the physeal growth plate are common, particularly Salter-Harris type II through the dorsal aspect of the distal radial metaphysis (again due to FOOSH):</li> 436</ul> 437 438<div class="text-center mb-4"><a href="images/wrist/SH1,%20ULNA%20STYLOID.jpg" title="Salter-Harris I" class="MagicZoom"><img class="tn img-thumbnail" alt="Salter-Harris I" src="images/wrist/SH1,%20ULNA%20STYLOID-1.jpg"></a> 439<a href="images/wrist/SH2,%20ULNA%20STYLOID.jpg" title="Salter-Harris II" class="MagicZoom"><img class="tn img-thumbnail" alt="Salter-Harris II" src="images/wrist/SH2,%20ULNA%20STYLOID-1.jpg"></a></div> 440</div> 441</div> 442 443 444 445<div class="card border-dark mb-3" > 446 <div class="card-header" id="scaphoid">Scaphoid</div> 447 <div class="card-body text-dark"> 448 449<ul> 450<li>Majority of fractures are at the waist and are non-displaced. Can be difficult to see initially, therefore if clinically suspected repeat radiographs are taken at 10-14 days to demonstrate sclerosis or resorption at the fracture line:</li> 451</ul> 452 453<div class="text-center mb-4"><a href="images/wrist/scaphoid.jpg" title="Scaphoid - fracture demonstrated on follow up images (bottom)" class="MagicZoom"><img class="tn img-thumbnail" alt="Scaphoid - fracture demonstrated on follow up images (bottom)" src="images/wrist/scaphoid-1.jpg"></a></div> 454<ul> 455<li>Fractures at the distal pole are usually avulsion injuries caused by the radial collateral ligament. The distal pole has its own blood supply, so healing is quick.</li> 456</ul> 457 458<div class="text-center mb-4"><a href="images/wrist/%23%20DISTAL%20POLE%20SCAPHOID.jpg" title="Fracture distal pole scaphoid" class="MagicZoom"><img class="tn img-thumbnail" alt="Fracture distal pole scaphoid" src="images/wrist/%23%20DISTAL%20POLE%20SCAPHOID-1.jpg"></a></div> 459<ul> 460<li>Blood supply to the proximal pole enters at the waist. This supply may be cut off by a fracture through the waist. The proximal pole is consequently at risk from delayed union or avascular necrosis, where the proximal fragment collapses and becomes radiographically denser:</li> 461</ul> 462<div class="text-center mb-4"><a href="images/wrist/AVN%20SCAPHOID.jpg" title="AVN proximal pole of scaphoid" class="MagicZoom"><img class="tn img-thumbnail" alt="AVN proximal pole of scaphoid" src="images/wrist/AVN%20SCAPHOID-1.jpg"></a></div> 463<ul> 464<li>Clinical assessment of the injured scaphoid includes compression by axial loading which causes pain to the anatomical snuff-box. However, fractures to both the base of the 1st metacarpal and to the radial styloid will also produce pain to the anatomical snuff-box with this clinical assessment. It is therefore important to assess these areas carefully on the scaphoid views: 465</li> 466</ul> 467<div class="text-center mb-4"><a href="images/wrist/bennetts%20on%20scap.jpg" title="Bennett's fracture-dislocation" class="MagicZoom"><img src="images/wrist/bennetts%20on%20scap-1.jpg" alt="Bennett's fracture-dislocation" class="tn img-thumbnail" ></a></div> 468</div> 469</div> 470 471 472<div class="card border-dark mb-3" > 473 <div class="card-header" id="triquetrum">Triquetrum</div> 474 <div class="card-body text-dark"> 475 476<ul> 477<li>This is the second most common carpal bone to be fractured.</li> 478<li>An avulsed bony fragment will be demonstrated on the lateral radiograph, dorsal to the proximal row of carpal bones:</li> 479</ul> 480 481<div class="text-center mb-4"><a href="images/wrist/%23%20TRIQUETRUM.jpg" title="Triquetral fracture" class="MagicZoom"><img class="tn img-thumbnail" alt="Triquetral fracture" src="images/wrist/%23%20TRIQUETRUM-1.jpg"></a></div> 482</div> 483</div> 484 485<div class="card border-dark mb-3" > 486 <div class="card-header" id="hamate">
486Hamate</div> 487 <div class="card-body text-dark"> 488 489<ul> 490<li>Associated with fracture-dislocations at the base of the 4th and 5th metacarpals. Important to spot but often subtle.</li> 491<li>Ensure there is a 2mm joint space with the adjacent metacarpals on the DP view.</li> 492<li>Scrutinise the cortex of the hamate, particularly on an oblique view:</li> 493</ul> 494 495 496<div class="text-center mb-4"> 497<p><a href="images/wrist/Hamate.jpg" title="Fracture hamate" class="MagicZoom"><img class="tn img-thumbnail" alt="Fracture hamate" src="images/wrist/Hamate-1.jpg"></a></p> 498</div> 499</div> 500</div> 501 502 503<div class="card border-dark mb-3" > 504 <div class="card-header" id="lunate">Lunate</div> 505 <div class="card-body text-dark"> 506 507<h5><a id="lunate"></a></h5> 508<ul> 509<li>Fractures are rare. Lunate dislocations may occur following high impact trauma. A sclerotic lunate is sometimes seen, which is due to avascular necrosis (decreased blood supply), known as Keinbock's disease. The lunate becomes denser radiographically, fragments and collapses: 510</li> 511</ul> 512<div class="text-center mb-4"><a href="images/wrist/AVN%20LUNATE.jpg" title="AVN lunate" class="MagicZoom"><img src="images/wrist/AVN%20LUNATE-1.jpg" alt="AVN lunate" class="tn img-thumbnail"></a></div> 513</div> 514</div> 515 516 517 518<div class="card border-dark mb-3" > 519 <div class="card-header" id="pisiform">Pisiform</div> 520 <div class="card-body text-dark"> 521<ul> 522<li>Fractures very occasionally seen due to direct trauma to the antero-medial aspect of the carpus: 523</li> 524</ul> 525<div class="text-center mb-4"><a href="images/wrist/PISIFORM.jpg" title="Fracture pisiform" class="MagicZoom"><img src="images/wrist/PISIFORM-1.jpg" alt="Fracture pisiform" class="tn img-thumbnail" ></a></div> 526</div> 527</div> 528 529<div class="card border-dark mb-3" > 530 <div class="card-header" id="capitate">Capitate</div> 531 <div class="card-body text-dark"> 532 533<ul> 534<li>Isolated fractures are rare, but as part of complex carpal fractures and lunate/perilunate fracture-dislocations, a fracture of the capitate may be seen.</li> 535</ul> 536<div class="text-center mb-4"><a href="images/wrist/capitate%20and%20lunate.jpg" title="Comminuted fractures proximal capitate and lunate, with impaction and rotation" class="MagicZoom"><img src="images/wrist/capitate%20and%20lunate-1.jpg" alt="Comminuted fractures proximal capitate and lunate, with impaction and rotation" class="tn img-thumbnail" ></a> 537<a href="images/wrist/capitate%20graphic.jpg" title="Comminuted fractures proximal capitate and lunate, with impaction and rotation" class="MagicZoom"><img src="images/wrist/capitate%20graphic-1.jpg" alt="Comminuted fractures proximal capitate and lunate, with impaction and rotation" class="tn img-thumbnail"></a></div> 538</div> 539</div> 540 541<div class="card border-dark mb-3" > 542 <div class="card-header" id="trapezium">Trapezium</div> 543 <div class="card-body text-dark"> 544 545<ul> 546<li>Fractures are rare. The 1st carpo-metacarpal joint is a very common site for arthritic changes. 547</li> 548</ul> 549<div class="text-center mb-4"><a href="images/wrist/TRAPEZIUM,%20TRIQUETRAL.jpg" title="Fracture trapezium, fracture triquetral" class="MagicZoom"><img src="images/wrist/TRAPEZIUM,%20TRIQUETRAL-1.jpg" alt="Fracture trapezium, fracture triquetral" class="tn img-thumbnail" ></a></div> 550</div> 551</div> 552 553<div class="card border-dark mb-3" > 554 <div class="card-header" id="trapezoid">Trapezoid</div> 555 <div class="card-body text-dark"> 556 557<ul> 558<li>Fractures are rare.</li> 559</ul> 560</div> 561</div> 562 563 564<div class="card border-dark mb-3" > 565 <div class="card-header" id="Carpal_dislocations">Carpal Dislocations</div> 566 <div class="card-body text-dark"> 567 568 569<ul> 570<li>Lunate dislocation - Lunate loses its articulation with both the capitate and the radius and is displaced anteriorly with up to 90 degrees rotation. The capitate remains aligned with the radius but sinks proximally:</li> 571</ul> 572<div class="text-center mb-4"><a href="images/wrist/lunate%20dis%20dp.jpg" title="Lunate dislocation" class="MagicZoom"><img src="images/wrist/lunate%20dis%20dp-1.jpg" alt="Lunate dislocation" class="tn img-thumbnail" ></a> 573<a href="images/wrist/lunate%20dis.jpg" title="Lunate dislocation"class="MagicZoom"><img src="images/wrist/lunate%20dis-1.jpg" alt="Lunate dislocation" class="tn img-thumbnail"></a> 574<a href="images/wrist/lunate%20dis%20graphic.jpg" title="Lunate dislocation" class="MagicZoom"><img src="images/wrist/lunate%20dis%20graphic-1.jpg" alt="Lunate dislocation" class="tn img-thumbnail" ></a></div> 575<ul> 576<li>Perilunate dislocation - The lunate maintains its normal articulation with the radius, but the capitate articular surface is dislocated from the lunate, normally dorsally:</li> 577</ul> 578<div class="text-center mb-4"><a href="images/wrist/perilunate%20dis%20dp.jpg" title="Perilunate dislocation, fracture scaphoid" class="MagicZoom"><img src="images/wrist/perilunate%20dis%20dp-1.jpg" alt="Perilunate dislocation, fracture scaphoid" class="tn img-thumbnail" ></a> 579<a href="images/wrist/perilunate%20dis.jpg" title="Perilunate dislocation" class="MagicZoom"><img src="images/wrist/perilunate%20dis-1.jpg" alt="Perilunate dislocation" class="tn img-thumbnail"></a> 580<a href="images/wrist/perilunate%20dis%20graphic.jpg" title="Perilunate dislocation" class="MagicZoom"><img src="images/wrist/perilunate%20dis%20graphic-1.jpg" alt="Perilunate dislocation" class="tn img-thumbnail" ></a></div> 581<ul> 582<li>Midcarpal dislocation - The lunate tilts volarly but is not dislocated from the radius. The capitate is dislocated from the lunate but not as dorsally as seen in a perilunate dislocation:</li> 583</ul> 584<div class="text-center mb-4"><a href="images/wrist/midcarpal_dp.jpg" title="Midcarpal dislocation, fracture radial styloid" class="MagicZoom"><img class="tn img-thumbnail" alt="Midcarpal dislocation, fracture radial styloid" src="images/wrist/midcarpal_dp-1.jpg"></a> 585<a href="images/wrist/midcarpal_lat.jpg" title="Midcarpal dislocation" class="MagicZoom"><img src="images/wrist/midcarpal_lat-1.jpg" alt="Midcarpal dislocation" class="tn img-thumbnail"></a> 586<a href="images/wrist/midcarpal_graphic.jpg" title="Midcarpal dislocation" class="MagicZoom"><img src="images/wrist/midcarpal_graphic-1.jpg" alt="Midcarpal dislocation" class="tn img-thumbnail"></a></div> 587</div> 588</div> 589 590 591<div class="card border-dark mb-3" > 592 <div class="card-header" id="zov">Zone of vulnerability</div> 593 <div class="card-body text-dark"> 594 595<ul> 596<li>Most fracture-dislocations fall within the "zone of vulnerability".</li> 597<li>When identifying a fracture or dislocation, it is helpful to understand that likely associated fractures will be within this zone, i.e., radial styloid, waist of the scaphoid or capitate, proximal pole of the hamate, triquetrum or ulnar styloid.</li> 598<li>With progression from the radial to the ulnar side of the arch, the severity of the injury increases and the frequency of the injury decreases:</li> 599</ul> 600 601<div class="text-center mb-4"><a href="images/wrist/NORMAL%20WRIST%20ZONE%20graphic.jpg" title="Zone of vulnerability" class="MagicZoom"><img src="images/wrist/NORMAL%20WRIST%20ZONE%20graphic-1.jpg" alt="Zone of vulnerability" class="tn img-thumbnail" ></a></div> 602</div></div> 603 604<div class="card border-dark mb-3" > 605 <div class="card-header" id="carpalInstability">Carpal instability</div> 606 <div class="card-body text-dark"> 607 608<ul> 609<li>Refers to ligament rupture within the carpal bones, most commonly at the scapho-lunate joint.</li> 610<li>Scapholunate dissociation is demonstrated by the gap between the scaphoid and lunate increasing in size more than 2mm. It may al
610so become triangular in appearance on the PA radiograph.</li> 611<li>There is foreshortening of the scaphoid and a cortical "ring sign" is seen at the distal pole:</li> 612</ul> 613 614<div class="text-center mb-4"><a href="images/wrist/CARPAL%20INSTABILITY.jpg" title="Carpal instability" class="MagicZoom"><img class="tn img-thumbnail" alt="Carpal instability" src="images/wrist/CARPAL%20INSTABILITY-1.jpg"></a> 615</div> 616<ul> 617<li>A 'clenched fist' view is sometimes helpful to demonstrate the widening at the joint:</li> 618</ul> 619<div class="text-center mb-4"><a href="images/wrist/CARPAL%20INSTABILITY%20CLENCHED%20%20FIST.jpg" title="Clenched fist view" class="MagicZoom"><img class="tn img-thumbnail" alt="Clenched fist view" src="images/wrist/CARPAL%20INSTABILITY%20CLENCHED%20%20FIST-1.jpg"></a></div> 620</div> 621</div> 622 623<div class="card border-dark mb-3" > 624 <div class="card-header" id="galeazzi">Galeazzi fracture-dislocation</div> 625 <div class="card-body text-dark"> 626 627<ul> 628<li>Refers to a displaced fracture of the radial shaft accompanied by a dislocation to the distal radioulnar joint:</li> 629</ul> 630<div class="text-center mb-4"><a href="images/wrist/GALLEAZZI.jpg" title="Galeazzi fracture-dislocation" class="MagicZoom"><img class="tn img-thumbnail" alt="Galeazzi fracture-dislocation" src="images/wrist/GALLEAZZI-1.jpg"></a></div> 631<ul> 632<li>Similar pattern seen at the elbow where a displaced fracture to the proximal ulna is accompanied by a dislocation of the radial head. This is termed a <a href="elbow.php#Monteggia">"Monteggia" fracture-dislocation</a>.</li> 633</ul> 634</div> 635</div> 636 637<div class="text-center mb-4"> 638<p><a href="self_test.php?new=1"><i class="fas fa-university fa-5x"></i> 639TAKE THE WRIST SELF-TEST</a></p> 640<p> </p> 641</div> 642<p class="text-center mb-4"><a href="#top">- return to top -</a></p> 643</div> 644 645 646 647 648 649 650 651 652 653<div class="footer"> 654<div class="container text-center"> 655 <small>© 2008-2026 Heidi & <a href='https://www.medicalwebsystems.co.uk' target='_blank'>David Nunn</a>. All rights reserved. </small> 656</div> 657 658</div> 659 660</div> 661<div class="end"> </div> 662 663
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