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