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  • 1. TRAUMA IN WRIST JOINT
  • 2. CASE PRESENTATION • A 20 YR OLD MAN CAME WITH H/O TRAUMA TO RIGHT WRIST JOINT CAME WITH COMPLAINTS OF – Swelling around the wrist joint – Inability to move wrist
  • 3. PLAIN XRAY OF WRIST SHOWS
  • 4. ON TRACTION
  • 5. SO MY DIAGNOSIS IS • A PLAIN X RAY AP AND LATERAL VIEW OF LEFT WRIST JOINT SHOWING – TRANSSCAPHOID PERILUNATE DISLOCATION OF WRIST JOINT – FRACTURE WAIST OF SCAPHOID – FRACTURE ULNAR STYLOID PROCESS – INTRA ARTICULAR FRACTURE OF BASE OF FIRST METACARPAL (BENNET’S FRACTURE) – TRANSVERSE # DISTAL END OF FIRST METACARPAL
  • 6. RADIOLOGIC ANATOMY OF WRIST JOINT
  • 7. LATERAL RADIOGRAPH
  • 8. FEW TERMINOLOGIES NEUTRAL VARIANCE WITH NORMAL ANATOMY OF
  • 9. THE NORMAL ULNAR SLANT
  • 10. THE PALMAR INCLINATION OF RADIUS
  • 11. 5 MM 8 MM NEGATIVE ULNAR VARIANCE POSITIVE ULNAR VARIANCE
  • 12. Views in wrist joint • Dorsovolar view in ulnar deviation – scaphoid • Supinated oblique – Pisiform bone and pisotriquetral joint • Pronated oblique – Triquetral – Radiovolar aspect of scaphoid – Radial styloid • Carpel tunnel view – Hook of hamate – Pisiform – Volar aspect of trapezium
  • 13. ULNAR DEVIATION VIEW
  • 14. SUPINATED OBLIQUE VIEW
  • 15. PRONATED OBLIQUE VIEW
  • 16. CARPAL TUNNEL VIEW
  • 17. TRAUMATIC LESIONS OF WRIST
  • 18. SCAPHOID FRACTURE
  • 19. CT SCAN REVEALS THE HUMPBACK DEFORMITY IN SCAPHOID FRACTURE PALMAR FLEXION OF DISTAL FRAGMENT AND DORSI APEX ANGULATION
  • 20. • CLASSIFIED BY LOCATION AS – TUBERCLE [5-10%] – DISTAL POLE – WAIST [70-80%] – PROXIMAL POLE [10-15%] • COMPLICATIONS – NON UNION – OSTEONECROSIS – POST TRAUMATIC ARTHRITIS
  • 21. FRACTURE OF TRIQUETRUM
  • 22. FRACTURE OF HAMATE BONE
  • 23. FRACTURE PISIFORM • RARE DUE TO FALL ON OUTSTRECTCHED ARM OR HIT BY A HAMMER
  • 24. FRACTURE OF LUNATE • FALL ON DORSIFLEX HAND OR STRENOUS PULL OF HAND • PERILUNATE DISLOCATION • SECONDARY TO KIENBOCH,S DISEASE
  • 25. # LUNATE NOTED MORE CLEARLY ON LATERAL VIEW
  • 26. FRACTURE OF CAPITATE
  • 27. KEINBOCH’S DISEASE
  • 28. DISLOCATION OF CARPAL BONES VULNERABLE ZONES OF THE WRIST JOINT •LESSER ARC SHOWS THE DISLOCATION ZONE •GREATER ARC SHOWS THE FRACTURE DISLOCATION ZONE
  • 29. SCAPHOTRAPEZIUM (RADIAL LINK) AND TRIQUETROHAMATE (ULNAR LINK) JOINTS
  • 30. STAGE 1 – SCAPHOLUNATE FAILURE WITH SUBLUXATION OF SCAPHOID STAGE 2- CAPITOLUNATE FAILURE WITH DISLOCATION OF CAPITATE (PERILUNATE DISLOCATION) STAGE 3 – TRIQUETROLUNATE FAILURE WITH MIDCARPAL DISLOCATION STAGE 4 – COMPLETE LUNATE DISRUPTION WITH DORSAL RADIOCARPAL LIGAMENT FAILURE
  • 31. NORMAL A N ATO M I C A L O R I E N TAT I O N WITH RADIUS LU N AT E C A P I TAT E A N D 3 RD M E TA C A R PA L IN SAME AXIS
  • 32. BREAK OF THE LONGITUDINAL LIGAMENT OF 3RD METACARPAL ARC 2 AND 3 DISRUPTED CLASSICAL PICTURE OF PERILUNATE DISLOCATION
  • 33. FRACTURE OF SCAPHOID WITH INCONCLUSIVE ARRANGEMENT OF ARCS CAPITATE NOTED DORSAL TO LUNATE SUGGESTIVE TRANSSCAPHOID PERILUNATE DISLOCATION
  • 34. Isolated scaphoid dislocation
  • 35. Transradial, transscaphoid, transtri quetral lunate dislocation
  • 36. TERRY THOMAS SIGN WIDENING OF SPACE BETWEEN SCAPHOID AND LUNATE MS MORE THAN 2 MM SIGN OF SCAPHOLUNATE DISLOCATION
  • 37. CORTICAL SHADOW NOTED OVER SCAPHOID DUE TO BONES DORSAL TILT CAUSING IT TO BE SEEN END ON THIS IS EXAGGERATED BY RADIAL DEVIATION CALLED AS THE SIGNET RING SIGN
  • 38. DISLOCATION OF LUNATE WITH BREAK OF LONGITUDINAL LIGAMENT OF 3RD METACARPAL LIGAMENT DISTRUPTION OF ARC 2 SUGGESTIVE OF MAL ALIGNMENT LUNATE DISLOCATION
  • 39. SCAPHOID D I S L O C AT I O N WITH AXIAL C A R PA L DISRUPTION RADIAL VOLAR DISLOCATION OF SCAPHOID PROXIMAL MIGRATION OF CAPITATE INTERRUPTION OF 3RD ARC OF CARPUS AND # OF BASE OF 4TH METACARPAL