Wrist Anatomy and Ossification Quiz

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Questions and Answers

What type of injury is typically associated with a Colle's fracture?

Fall on an outstretched hand (correct)

Direct blow to the wrist

Overuse of wrist during sports

Twisting motion of the wrist

Which of the following fractures is characterized by incomplete fracture with the opposite cortex still intact?

Colle's fracture

Smith's fracture

Kienbock's disease

Greenstick fracture (correct)

What is the characteristic feature of Kienbock's disease?

Ventral displacement of the wrist

Fracture of the scaphoid

Chalky appearance of the radius

Avascular necrosis of the lunate (correct)

What does the abbreviation ORIF stand for in surgical procedures?

Open Reduction Internal Fixation Signup and view all the answers

How is a Smith's fracture typically caused?

Fall on the back of the hand or direct blow Signup and view all the answers

What is a common physical finding in patients with a Colle's fracture?

Dorsal displacement of the wrist Signup and view all the answers

Which of the following is not a potential outcome of Kienbock's disease?

Fracture of the scaphoid Signup and view all the answers

What imaging method is utilized during an ORIF procedure for visualizing the prosthesis placement?

Image intensifier Signup and view all the answers

What is the first carpal bone to ossify?

Capitate Signup and view all the answers

Which position is required for the PA Axial Wrist with Ulnar Deviation?

Wrist in PA position with maximum ulnar deviation Signup and view all the answers

What should be done to ensure no excessive flexion of digits during a PA Wrist X-ray?

Ensure the fingers are slightly elevated Signup and view all the answers

Which part of the wrist is highlighted during a scaphoid view?

Scaphoid with adjacent articulations Signup and view all the answers

In a Lateral Wrist X-ray, what is the positioning requirement for the radius and ulna?

They should be superimposed Signup and view all the answers

Which carpal bone takes the longest to ossify?

Pisiform Signup and view all the answers

What is a common indication for wrist imaging?

Pain or reduced range of movement Signup and view all the answers

What angle should the X-ray tube be positioned for the PA Axial Wrist with Ulnar Deviation?

10-15 degrees Signup and view all the answers

During which X-ray view is the radial aspect of the wrist elevated?

PA Oblique Wrist Signup and view all the answers

What is the appropriate kVp setting for the Lateral Wrist X-ray?

55 kVp Signup and view all the answers

Which structure must be visualized clearly in a PA Wrist evaluation?

Soft tissue and bony trabecular detail Signup and view all the answers

What characteristic indicates proper collimation in a wrist X-ray?

Clear outline of distal radius and ulna Signup and view all the answers

What is the most common site for scaphoid fractures?

Waist or middle third Signup and view all the answers

What should be clearly shown in a PA Oblique Wrist evaluation?

Trapezium without superimposition Signup and view all the answers

Study Notes

Wrist Anatomy

The carpal bones of the wrist include the scaphoid, lunate, triquetrum, pisiform, hamate, capitate, trapezoid, and trapezium.
The scaphoid is a small bone located on the thumb side of the wrist.

Ossification of the Wrist

The capitate ossifies between 1 and 3 months of age.
The hamate ossifies between 2 and 4 months of age.
The triquetrum ossifies between 2 and 3 years of age.
The lunate ossifies between 2 and 4 years of age.
The scaphoid ossifies between 4 and 6 years of age.
The trapezium ossifies between 4 and 6 years of age.
The trapezoid ossifies between 4 and 6 years of age.
The pisiform ossifies between 8 and 12 years of age.

Indications for a Wrist X-ray

Pain in the wrist
Loss of function in the hand
Lumps in the wrist
Deformity of the wrist
Foreign bodies in the wrist
Decreased range of motion of the wrist
Swelling in the wrist
Infections
Trauma, such as a fall on an outstretched hand (FOOSH)
Cuts in the wrist
Bruising in the wrist

Patient Preparation for a Wrist X-ray

Ensure correct patient identification.
Check for pregnancy if applicable.
Explain the procedure to the patient.
Remove any jewelry from the wrist, including rings, bracelets, and watches.
Position the patient sitting in a chair with the affected side closest to the table.
Ensure the patient's knees are not under the table.
Adjust table height to allow the patient's forearm to rest comfortably in line.
Apply a lead apron for radiation protection.

PA Wrist X-ray

Position: Patient sitting with palm on the imaging plate, fingers slightly raised.
Centering: Perpendicular to the mid carpal area.
Collimation: Include proximal metacarpals and 1/3 of radius and ulna.

Evaluation Criteria for PA Wrist

Evidence of proper collimation.
Clear visualization of the distal radius, ulna, carpals, and proximal half of metacarpals.
No overlapping of metacarpals due to excessive digit flexion.
No rotation in carpals, metacarpals, radius, and ulna.
Open radioulnar joint space.
Visible soft tissue and bony trabecular detail.

PA Oblique Wrist X-ray

Position: From PA position, rotate hand and wrist 45 degrees so radial aspect is elevated (thumb up).
Centering: Perpendicular to mid carpal area, just distal to radius.
Collimation: Include proximal metacarpals and 1/3 of the radius and ulna.

Evaluation Criteria for PA Oblique Wrist

Evidence of proper collimation.
Clear visualization of the distal radius, ulna, carpals, and proximal half of metacarpals.
45-degree rotation of anatomy.
Slight interosseous space between the third, fourth, and fifth metacarpal bodies.
Slight overlap of the distal radius and ulna.
Visible carpals on lateral side of the wrist.
Trapezium and distal half of the scaphoid without superimposition.
Open trapeziotrapezoid and scaphotrapezial joint space.
Visible soft tissue and bony trabecular detail.

Lateral Wrist X-ray

Position: From PA position, rotate hand and wrist 90 degrees (ulna aspect in contact with the imaging plate).
Centering: At the level of the styloid processes.
Collimation: Include proximal metacarpals and 1/3 of the radius and ulna.

Evaluation Criteria for Lateral Wrist

Evidence of proper collimation.
Clear visualization of the distal radius, ulna, carpals, and proximal half of metacarpals.
Superimposed distal radius and ulna.
Superimposed metacarpals.
Visible soft tissue and bony trabecular detail.

PA Axial Wrist with Ulnar Deviation (Scaphoid View)

Position: From PA position, adduct fingers/hand (ulnar deviation) without moving forearm.
Centering: To the scaphoid.
Collimation: Close collimation of the carpals.
Angle: 10-15 degrees along the long axis of the forearm proximally.

Evaluation Criteria for Scaphoid View

Evidence of proper collimation.
Clear visualization of the distal radius, ulna, carpals, and proximal half of metacarpals.
Scaphoid and its adjacent articulations are open.
No rotation of the wrist.
Maximum ulnar deviation, as revealed by the angle between the ulna's longitudinal axis and the fifth metacarpal’s longitudinal axis.
Visible soft tissue and bony trabecular detail.

Scaphoid Fractures

Scaphoid fractures are most common at the waist (70%), followed by the distal pole (20%) and proximal pole (10%).
Scaphoid fractures may not be visible on initial x-rays and can become clearer over time.

Greenstick Fractures

Incomplete fractures with the opposite cortex intact.
Common in infants and children.

Colles' Fracture

Dorsal displacement of the distal radius, often seen in patients with osteoporosis or high impact injuries.
Typically caused by a fall on an outstretched hand (FOOSH).

Smith's Fracture

Ventral displacement of the distal radius, often considered a reverse Colle's fracture.
Typically caused by a fall on the back of the hand or a direct blow.

Kienbock's Disease

Avascular necrosis of the lunate, characterized by a dense, chalky white, sclerotic appearance.
May lead to cystic degeneration, fragmentation, collapse, loss of carpal height, and scaphoid rotation.

Open Reduction Internal Fixation (ORIF)

Surgical procedure involving open reduction and internal fixation of a bone fracture.
Radiographers use an image intensifier (II) during surgery to assist surgeons in placing prostheses and implants.

Wrist Fusion

A surgical procedure used to fuse two or more bones in the wrist.
Performed to immobilize the wrist joint and reduce pain.

Wrist Prostheses

Artificial implants used to replace the wrist joint.
May be used to treat severe arthritis or injury.

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Description

Test your knowledge on the anatomy of the wrist, including the carpal bones and their ossification timings. This quiz also covers indications for wrist X-rays and their importance in diagnosing wrist issues. Perfect for anatomy students or those in medical training.