Never Conclude Fractures on One Projection

The good old Radiographic principle revisited

Never conclude on one projection. Example by Dr MGK Murthy.

Patient with history of  fall

Frontal oblique apparently comfortable with soft tissue shadow  in the vicinity  of  fifth digit with  mild curvature of metacarpalin the region

Lo  behold!!

Do another projection and we have stippled pieces of bone in the vicinity of proximal row carpus possibly emanating from triquetral. Triquetral fractures are best seen on lateral radiograph and are due to  forced hyper flexion injuries  due to attachment of  Radiocarpal ligament

Remember acceptable  criterion for True lateral wrist

Radiograph for scapho –piso- capitate alignment -Ventral cortex of pisiform shows between ventral cortices of distal pole of scaphoid and head of capitate. Our X ray fits in to acceptable criterion (but not excellent) as pisiform is over the scaphoid almost completely

What do we do?

 We go for  MRI (to exclude extensor carpi ulnaris tendon and other soft tissue injuries apart from marrow edema delineation) and if necessary for MDCT after that

Whoever said Plain X rays are simple  with digital  technology