 The wrist has 8 carpal bones that fit closely together and are arranged into

2 horizontal rows
 The carpals are classified as short bones and are composed largely of
cancellous tissue with an outer layer of compact bony tissue
 The proximal row of carpals: scaphoid, lunate, triquetrum, pisiform
 The distal row of carpals: trapezium, trapezoid, capitate, hamate
 Bennet fracture- fracture at the base of the 1st metacarpal
 Boxer fracture- fracture of metacarpal neck
 Colles fracture- fracture of distal radius with posterior (dorsal)
displacement
 Smith fracture- fracture of distal radius with anterior (palmer) displacement
 Torus or buckle fracture- impacted fracture with bulging of periosteum

 First Carpometacarpal Joint

o AP projection {Robert Method}
o Extend the extremity straight out on the radiographic table
o Rotate the arm internally to place the posterior aspect of the thumb
on the IR with the thumbnail down
o Robert method: CR perpendicular entering at the first CMC joint
o Long and Rafert method: CR angles 15o proximally along the long axis
of the thumb and entering the first CMC joint
o Lewis modification: angles 10o-15o proximally along the long axis of
the thumb and entering the first MCP joint
 PA projection of Wrist
o Have the patient rest the forearm on the table, then center the wrist
joint to the IR area. The wrist (radiocarpal) joint is at a level just distal
to the ulnar styloid
o When it is difficult to determine the exact location of the radiocarpal
joint because of a swollen wrist, ask the patient to flex the wrist
slightly, and center the IR to the point of flexion. When the wrist is in
a splint or cast the exact point of centering can be determined by
comparison with the opposite side
o Adjust the hand and forearm to lie parallel with the long axis of the
IR
o Slightly arch the hand by flexing the digits to place the wrist in close
contact with the IR
o When necessary, place a support under the digits to immobilize them
o CR: perpendicular to the midcarpal area
o Collimation: adjust radiation field to 2.5 inches proximal and distal to
the wrist joint and 1 inch on the sides
o Structures shown: a PA projection of the carpals, distal radius and
ulna, and proximal metacarpals
o Evaluation criteria:
 Distal radius and ulna, carpals, and proximal half of
metacarpals
 Open radioulnar joint space

 AP projection of wrist
o Structures shown: the Carpal Interspaces are better shown in the AP
image than in the PA image. Because of the oblique direction of the
interspaces they are more closely parallel with the divergence of the
x-ray beam
 Lateral projection of wrist
o Have the patient rest the arm and forearm on the table to ensure the
upper extremity is aligned in the same plane
o Have the patient flex the elbow 90o to rotate the ulna to the lateral
position
o Center the IR to the wrist (radiocarpal) joint
o Adjust the forearm and hand, placing the humeral epicondyles and
styloid processes superimposed and perpendicular to the IR so that
the wrist is in a true lateral position
o CR: perpendicular to the wrist joint
o Collimation: adjust radiation field to 2.5 inches proximal and distal to
the wrist joint and 1 inch on the palmar and dorsal surfaces
o Structures shown: a lateral projection of the proximal metacarpals,
carpals, and distal radius and ulna. Can also show anterior or
posterior displacement of fractures
o Evaluation Criteria:
 distal radius and ulna, carpals, and proximal half of
metacarpals
 superimposed radius and ulna
 superimposed metacarpals
o Fiolle was the first to describe a small bone growth occurring on the
dorsal surface of the 3rd CMC joint. He termed the condition carpe
bossu {carpal boss} and found that it is shown best in a lateral
position with the wrist in palmer flexion
 PA oblique projection of wrist
o Rest the palmer surface of the wrist on the IR
o Adjust the IR so that the center point is under the scaphoid when the
wrist is rotated from the pronated position
o From the pronated position, rotate the wrist laterally (externally)
until the coronal plane forms and angle of approximately 45o with
the plane of the IR
o Extend the wrist slightly, and if the digits do not touch the table,
support them in place
o When the scaphoid is under examination, adjust the wrist in ulnar
deviation. Place a sandbag across forearm
o CR: perpendicular to the midcarpal area; it enters just distal to the
radius
o Collimation: adjust radiation field to 2.5 inches proximal and distal to
the wrist joint and 1 inch on the sides
o Structures shown: the carpals on the lateral side of the wrist
particularly the trapezium and the scaphoid. The scaphoid is
superimposed on itself in the direct PA projection
o Evaluation Criteria:
 Distal radius and ulna, carpals, and proximal half of
metacarpals
 45o rotation of anatomy
 Slight interosseous space between the 3rd, 4th, and 5th
metacarpal bodies
 Slight overlap of the distal radius and ulna
 Carpals on lateral side of wrist
 Open trapezoitrapezoid and scaphotrapezial joint space
 AP oblique projection of wrist
o Have the patient rest the forearm on the table in the supine position
o Place the IR under the wrist and center it at the dorsal surface of the
wrist
o Rotate the wrist medially (internally) until the coronal plane forms an
angle of approximately 45o to the plane of the IR
o CR: perpendicular to the midcarpal area; it enters the anterior
surface of the wrist midway between its medial and lateral borders
o Collimation: adjust radiation field to 2.5 inches proximal and distal to
the wrist joint and 1 inch on the sides
o Structure Shown: this position separates the pisiform from adjacent
carpal bones. It also provides a more distinct radiograph of the
triquetrum and hamate
o Evaluation Criteria:
 Distal radius and ulna, carpals, and proximal half of
metacarpals
 Carpals on medial side of wrist
 Triquetrum, hook of hamate, and pisiform free of
superimposition and in profile
 PA Projection ulnar deviation
o CR: perpendicular to the scaphoid
o Structures Shown: this position reduces foreshortening of the
scaphoid, which occurs with a perpendicular CR. It also opens the
spaces between adjacent carpals
 PA projection radial deviation
o CR: perpendicular to midcarpal area
o Structures shown: radial deviation opens the interspaces between
the carpals on the medial side of the wrist