Kendrick Lee , MD Private Practice, Oakland, California

The PA view on the left shows a disturbing finding: the lunate is not resting the proper distance from the main line of the distal radius, as seen below the scaphoid. Lou Gilula, the wrist radiologist in St Louis, has a principle of the wrist radiograph: all joint spaces should be equal. The lunate is unusually high above the radius. With closer inspection, you can see that there is a far ulnar portion of the distal radius that is the proper distance from the lunate. This suggests that there is a dorsal ulnar fragment that is not well seen. An oblique view would might show this, and the patient was sent back for one additional view of each side.

Figure 3 Left hand injury films

Notice how large the fragment looks on the oblique. Unfortunately, the tech did not actually get an oblique of the right, just another PA view.

Figure 4 Right hand injury films

The snake in the grass is the scaphoid fracture on the right.

(4) What are your treatment options? Which one would you choose? For the left? For the right?

The case continues on the next page >>>

Jump to page: 1 3 4 5 6 7 8 9