The Wrist and Scaphoid - Compatibility Mode PDF

THE WRIST AND SCAPHOID University of Newcastle’s Department of Rural Health Amanda in Tamworth Gina in Coffs Harbour Hayden in Port Macquarie ANATOMY: Carpal Bones Scaphoid Lunate T...

THE WRIST AND SCAPHOID University of Newcastle’s Department of Rural Health Amanda in Tamworth Gina in Coffs Harbour Hayden in Port Macquarie ANATOMY: Carpal Bones Scaphoid Lunate Triquetrum Pisiform Hamate Capitate Trapezoid Trapezium  ANATOMY OF THE WRIST: http://www.wikiradiography.net/page/Wrist_Radiographic_Anatomy OSSIFICATION CENTRE OF THE WRIST: ► Capitate: 1-3 months ► Hamate: 2-4 months ► Triquetral: 2-3 years ► Lunate: 2-4 years ► Scaphoid: 4-6 years ► Trapezium: 4-6 years ► Trapezoid: 4-6 years https://link.springer.com/article/10.1007/s13534-020-00151-y ► Pisiform: 8-12 years INDICATIONS: ► Pain ► Loss of function – poor hand ► Lumps grasp ► Deformity ► Foreign Body ► Reduced Range of Movement ► Swelling (ROM) ► Infections ► Trauma - FOOSH – fall on ► Cuts outstretched hand ► Bruising PATIENT PREPARATION: ► Correct Patient Identification ► Pregnancy Check (if applicable) ► Explanation of Procedure ► Remove jewellery (Rings, bracelets and watches etc..) ► Patient seated on chair with affected side next to the table, make sure knees are not under the table ► Table height to the level where their forearm is resting comfortably in line ► Lead apron Image supplied by lecturer PA WRIST: Xray: kVp: PA Wrist 52kVp mAs: 3.2mAs FFD: 100-110cm CR: 24x30 plate DR: Imaging Receptor Cassette: Long axis of cassette parallel with long axis of hand and forearm Centre: Perpendicular to mid carpal area Collimation: Include the proximal metacarpals and 1/3 of the radius and ulna Pt sitting at end of table so legs aren't in primary beam Flex elbow at 90deg Patient Position: Pt's palm on the imaging plate (PA) Raise the fingers slightly so the anterior aspect of the wrist is in contact with the imaging plate EVALUATION CRITERIA PA WRIST: The following should be clearly shown: Evidence of proper collimation Distal radius and ulna, carpals, and proximal half of metacarpals No excessive flexion of digits to overlap and obscure metacarpals No rotation in carpals, metacarpals, radius, and ulna Open radioulnar joint space Soft tissue and bony trabecular detail  PA OBLIQUE WRIST: Xray: PA Oblique Wrist kVp: 52kVp mAs: 3.2mAs FFD: 100-110cm (depending on system) CR: 24x30 plate DR: Imaging Receptor Cassette: Long axis of cassette parallel with long axis of hand and forearm Centre: Perpendicular to mid carpal area; just distal to radius Collimation: Include the proximal metacarpals and 1/3 of the radius and ulna Pt sitting at end of table so legs aren't in primary beam Flex elbow at 90deg Patient Position: From PA position rotate hand and wrist 45deg so radial aspect is elevated (thumb up) A 45deg sponge may be used to support the hand and wrist  EVALUATION CRITERIA PA OBLIQUE WRIST: The following should be clearly shown: Evidence of proper collimation Distal radius and 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 Carpals on lateral side of wrist Trapezium and distal half of the scaphoid without superimposition Open trapeziotrapezoid and scaphotrapezial joint space Soft tissue and bony trabecular detail LATERAL WRIST: Xray: kVp: Lateral Wrist 55kVp mAs: 3.2mAs FFD: 100-110cm (depending on system) CR: 24x30 plate DR: Imaging Receptor Cassette: Long axis of cassette parallel with long axis of hand and forearm Centre: At the level of the styloid processes Collimation: Include the proximal metacarpals and 1/3 of the radius and ulna Pt sitting at end of table so legs aren't in primary beam Patient Position: Flex elbow at 90deg From oblique position rotate hand and wrist a further 45deg (90deg to PA) Ulna aspect is placed in contact with the imaging plate Palpate for ulna and radial styloid processes and ensure they are directly superimposed EVALUATION CRITERIA LATERAL WRIST: The following should be clearly shown: Evidence of proper collimation Distal radius and ulna, carpals, and proximal half of metacarpals Superimposed distal radius and ulna Superimposed metacarpals Soft tissue and bony trabecular detail ANATOMY of the LATERAL WRIST: http://www.wikiradiography.net/page/Wrist_Radiographic_Anatomy  PA AXIAL WRIST with ULNAR DEVIATION (SCAPHOID VIEW) Xray: PA AXIAL WRIST with ULNAR DEVIATION kVp: 55kVp mAs: 3.2mAs FFD: 100-110cm (depending on system) CR: 24x30 plate DR: Imaging Receptor Cassette: Long axis of cassette parallel with long axis of hand and forearm Centre: To the scaphoid Angle the xray tube 10-15 deg along the long axis of the forearm proximally Collimation: Close collimation of the carpals Pt sitting at end of table so legs aren't in primary Patient Position: beam Flex elbow at 90deg Position wrist in the PA wrist position Without moving the forearm adduct the fingers/hand (ulnar deviation)  EVALUATION CRITERIA SCAPHOID VIEW: The following should be clearly shown: Evidence of proper collimation Distal radius and ulna, carpals, and proximal half of metacarpals Scaphoid with adjacent articulations open No rotation of wrist Maximum ulnar deviation, as revealed by the angle formed between the longitudinal axis of the ulna and the longitudinal axis of the fifth metacarpal Soft tissue and bony trabecular detail SCAPHOID FRACTURE SITES: Waist - middle third - 70% Distal third (distal pole) - 20% Proximal third (proximal pole) - 10% https://www.rch.org.au/clinicalguide/guideline_index/fractur es/Scaphoid_Fractures_%E2%80%93_Emergency_Management/ ► Sometimes Scaphoid #’s aren’t seen on xray at the time of injury. ► They can show up clearly at the 6 week mark. 12 hours after injury 1 week after injury 3 months after injury https://radiopaedia.org/cases/scaphoid-fracture-12 GREENSTICK FRACTURE: ► Incomplete fracture with the opposite cortex intact. Often found in infants/children. Image supplied by lecturer Is this an old fracture? Why?? COLLE’S FRACTURE: Fall on outstretched hand (FOOSH) Dorsal displacement Often seen in elderly patients with osteoporosis or in younger patients in high impact injuries https://radiopaedia.org/articles/colles-fracture SMITH’S FRACTURE: Fall on back of hand or direct blow Ventral displacement Can be thought of as “reverse Colle’s” https://radiopaedia.org/articles/smith-fracture?lang=us KEINBOCK’S DISEASE: avascular necrosis of lunate dense, chalky white, sclerotic appearance cystic degeneration, fragmentation, collapse, loss of carpal height, scaphoid rotation https://orthoinfo.aaos.org/en/diseases--conditions/kienbocks-disease/  WRIST ORIF: ► Open Reduction Internal Fixation ► Radiographer uses an image intensifier (II) in theatre for the surgeon to see the placement of the prosthesis http://www.wikiradiography.net/page/Top_20_Pract ical_Tips_for_Radiography_in_the_Operating_Theatre https://radiopaedia.org/articles/volar-locking-plate  WRIST FUSION: Image supplied by lecturer Prosthesis: Image supplied by lecturer REFERENCES: ► Bontrager, K. L. (2005) Textbook of Radiographic Positioning and Related Anatomy. (6th edn.) St Louis: Mosby. ► Eisenberg, R. L. (2003) Comprehensive Radiographic Pathology (3rd edn.) St Louis: Mosby. ► McQuillen-Martensen, K. (1996) Radiographic Critique. Philadelphia : W.B. Saunders. ► Weir, J. & Abrahams, S. P. (2003) Imaging Atlas of Human Anatomy (3rd ed). London: Mosby. ► http://www.wikiradiography.net ► https://radiopaedia.org ► https://www.radiologymasterclass.co.uk/ REFERENCES: