Imaging of Wrist Trauma

Part of the Medical Radiology book series (MEDRAD)


This chapter will principally describe and illustrate acute bony injuries of the distal radius and carpus occurring as a result of trauma. Plain films form the bulk of investigations, but where indicated use of CT and MR imaging is also included. Chronic traumatic injuries principally overuse, or stress injuries will also be considered but in less detail.


Distal Radius Carpal Bone Scaphoid Fracture Proximal Pole Radial Styloid 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Adey L, Souer JS, Lozano-Calderon S, Palmer W, Lee SG, Ring D (2007) Computed tomography of suspected scaphoid fractures. J Hand Surg Am 32(1):61–66PubMedCrossRefGoogle Scholar
  2. Anderson MW (2006) Imaging of upper extremity stress fractures in the athlete. Clin Sports Med 25(3):489–504PubMedCrossRefGoogle Scholar
  3. Annamalai G, Raby N (2003) Scaphoid and pronator fat stripes are unreliable soft tissue signs in the detection of radiographically occult fractures. Clin Radiol 58(10):798–800PubMedCrossRefGoogle Scholar
  4. Barton JR (1838) Views and treatment of an important injury of the wrist. Med Exam 1:365–368Google Scholar
  5. Barton NJ (1992) Twenty questions about scaphoid fractures. J Hand Surg[Br] 17B:289–310CrossRefGoogle Scholar
  6. Beeres FJ, Hogervorst M, Rhemrev SJ, den Hollander P, Jukema GN (2007) A prospective comparison for suspected scaphoid fractures: bone scintigraphy versus clinical outcome. Injury 38(7):769–774PubMedCrossRefGoogle Scholar
  7. Brøndum V, Larsen CF, Skov O (1992) Fracture of the carpal scaphoid: frequency and distribution in a well-defined population. Eur J Radiol 15(2):118–122PubMedCrossRefGoogle Scholar
  8. Brookes-Fazakerley SD, Kumar AJ, Oakley J (2009) Survey of the initial management and imaging protocols for occult scaphoid fractures in UK hospitals. Skeletal Radiol 38(11):1045–1048PubMedCrossRefGoogle Scholar
  9. Brydie A, Raby N (2003) Early MRI in the management of clinical scaphoid fracture. Br J Radiol 76(905):296–300PubMedCrossRefGoogle Scholar
  10. Carter SR, Aldridge MJ, Fitzgerald R, Davies AM (1988) Stress changes of the wrist in adolescent gymnasts. Br J Radiol 61(722):109–112PubMedCrossRefGoogle Scholar
  11. Cerezal L, Abascal F, Canga A, García-Valtuille R, Bustamante M, del Piñal F (2000) Usefulness of gadolinium-enhanced MR imaging in the evaluation of the vascularity of scaphoid nonunions. AJR Am J Roentgenol 174(1):141–149PubMedCrossRefGoogle Scholar
  12. Davidson JS, Brown DJ, Barnes SN, Bruce CE (2001) Simple treatment for torus fractures of the distal radius. J Bone Joint Surg (Br) 83-B:1173–1175CrossRefGoogle Scholar
  13. Dawson JS, Martel AL, Davis TR (2001) Scaphoid blood flow and acute fracture healing a dynamic MRI study with enhancement with gadolinium. J Bone Joint Surg [Br] 83-B:809–814CrossRefGoogle Scholar
  14. De Schrijver F, De Smet L (2001) Fracture of the hook of the hamate, often misdiagnosed as “wrist sprain”. J Emerg Med 20(1):47–51PubMedCrossRefGoogle Scholar
  15. Dorsay TA, Major NM, Helms CA (2001) Cost-effectiveness of immediate MR imaging versus traditional follow-up for revealing radiographically occult scaphoid fractures. AJR 177:1257–1263PubMedCrossRefGoogle Scholar
  16. Dumontier C, Meyer zu Reckendorf G, Sautet A, Lenoble E, Saffar P, Allieu Y (2001) Radiocarpal dislocations: classification and proposal for treatment. A review of twenty-seven cases. J Bone Joint Surg Am 83-A(2):212–218PubMedGoogle Scholar
  17. Duncan DS, Thurston AJ (1985) Clinical fracture of the scaphoid–an illusionary diagnosis. J Hand Surg 10B(3):375–376Google Scholar
  18. Durr HR, Lienemann A, Stabler A, Kuehne J-H, Refior HJ (1997) MRI of posttraumatic cyst-like lesions of bone after a greenstick fracture. Eur Radiol 7:1218–1220PubMedCrossRefGoogle Scholar
  19. Dwek JR, Cardoso F, Chung CB (2009) MR imaging of overuse injuries in the skeletally immature gymnast: spectrum of soft-tissue and osseous lesions in the hand and wrist. Pediatr Radiol 39(12):1310–1316PubMedCrossRefGoogle Scholar
  20. Fernández DL (1993) Fractures of the distal radius: operative treatment. In: Heckman JD (ed) Instructional Course Lectures, vol 42. American Academy of Orthopaedic Surgeons, Park Ridge, pp 73–88Google Scholar
  21. Fisher MR, Rogers LF, Hendrix RW (1983) Systematic approach to identifying fourth and fifth carpometacarpal joint dislocations. Am J Roentgenol 140(2):319–324CrossRefGoogle Scholar
  22. Foex B, Speake P, Body R (2005) Best evidence topic report. Magnetic resonance imaging or bone scintigraphy in the diagnosis of plain X-ray occult scaphoid fractures. Emerg Med J 22(6):434–435PubMedCrossRefGoogle Scholar
  23. Frykman G (1967) Fracture of the distal radius including sequelae-shoulder-hand-finger syndrome, disturbance in the distal radio-ulnar joint and impairment of nerve function. A clinical and experimental study. Acta Orthop Scand Suppl 108:3Google Scholar
  24. Gaebler C (2006) Fractures and dislocations of the carpus. In: Buchholz RW, Heckmen JD, Court-Brown C (eds) Rockwood and green’s fractures in adults, 6th edn. Lippincott Williams & Wilkins, Philadelphia, pp 857–908Google Scholar
  25. Gemne G, Saraste H (1987) Bone and joint pathology in workers using hand-held vibrating tools. An overview. Scand J Work Environ Health 13(4):290–300PubMedCrossRefGoogle Scholar
  26. Gilula LA (1979) Carpal injuries: analytic approach and case exercises. Am J Roentgenol 133(3):503–517CrossRefGoogle Scholar
  27. Groves AM, Kayani I, Syed R, Hutton BF, Bearcroft PP, Dixon AK, Ell PJ (2006) An international survey of hospital practice in the imaging of acute scaphoid trauma. Am J Roentgenol 187(6):1453–1456CrossRefGoogle Scholar
  28. Houshian S, Pedersen NW, Torfing T, Venkatram N (2007) Post-traumatic cortical cysts in paediatric fractures: is it a concern for emergency doctors? A report of three cases. Eur J Emerg Med 14(6):365–367PubMedCrossRefGoogle Scholar
  29. Hudson TM, Caragol WJ, Kaye JJ (1976) Isolated rotatory subluxation of the carpal navicular. Am J Roentgenol 126(3):601–611CrossRefGoogle Scholar
  30. Ilyas A, Chaitanya C (2008) Radiocarpal fracture dislocations. J Am Acad Orthop Surg 16:647–655PubMedGoogle Scholar
  31. Johnson RP (1980) The acutely injured wrist and its residuals. Clin Orthop 149:33–44PubMedGoogle Scholar
  32. Jupiter JB, Fernandez DL (1997) Comparative classification for fractures of the distal end of the radius. J Hand Surg Am 22(4):563–571PubMedCrossRefGoogle Scholar
  33. Kaewlai R, Avery LL, Asrani AV, Abujudeh HH, Sacknoff R, Novelline RA (2008) Multidetector CT of carpal injuries: anatomy, fractures, and fracture-dislocations. Radiographics 28(6):1771–1784PubMedCrossRefGoogle Scholar
  34. Kato H, Nakamura R, Horii E, Nakao E, Yajima H (2000) Diagnostic imaging for fracture of the hook of the hamate. Hand Surg 5(1):19–24PubMedCrossRefGoogle Scholar
  35. Kumar S, O’Connor A, Despois M, Galloway H (2005) Use of early magnetic resonance imaging in the diagnosis of occult scaphoid fractures: the CAST Study. NZ Med J 118:1209Google Scholar
  36. La Hei N, McFadyen I, Brock M, Field J (2007) Scaphoid bone bruising–probably not the precursor of asymptomatic non-union of the scaphoid. J Hand Surg Eur Vol 32(3):337–340PubMedGoogle Scholar
  37. Leslie IJ, Dickson RA (1981) The fractured carpal scaphoid: natural history and factors influencing outcome. J Bone Joint Surg 63-B(2):225–230Google Scholar
  38. Liebling MS, Berdon WE, Ruzal-Shapiro C, Levin TL, Roye D Jr, Wilkinson R (1995) Gymnast’s wrist (pseudorickets growth plate abnormality) in adolescent athletes: findings on plain films and MR imaging. Am J Roentgenol 164(1):157–159CrossRefGoogle Scholar
  39. Lo IK, MacDermid JC, Bennett JD, Bogoch E, King GJ (2001) The radioulnar ratio: a new method of quantifying distal radioulnar joint subluxation. J Hand Surg Am 26(2):236–243PubMedCrossRefGoogle Scholar
  40. Low G, Raby N (2005) Can follow-up radiography for acute scaphoid fracture still be considered a valid investigation? Clin Radiol 60(10):1106–1110PubMedCrossRefGoogle Scholar
  41. Lozano-Calderón SA, Doornberg J, Ring D (2006) Fractures of the dorsal articular margin of the distal part of the radius with dorsal radiocarpal subluxation. J Bone Joint Surg Am 88:1486–1493PubMedCrossRefGoogle Scholar
  42. MacEwan DW (1964) Changes due to trauma in the fat plane overlying the pronator quadratus muscle: a radiologic sign. Radiology 82:879–881PubMedGoogle Scholar
  43. Magee T (2009) Comparison of 3-T MRI and arthroscopy of intrinsic wrist ligament and TFCC tears. Am J Roentgenol 192(1):80–85CrossRefGoogle Scholar
  44. Malchaire J, Maldague B, Huberlant JM, Croquet F (1986) Bone and joint changes in the wrists and elbows and their association with hand and arm vibration exposure. Ann Occup Hyg 30(4):461–468PubMedCrossRefGoogle Scholar
  45. May MM, Lawton JN, Blazar PE (2002) Ulnar styloid fractures associated with distal radial fractures: incidence and implications for distal radioulnar joint instability. J Hand Surg [Am] 27(6):965–971CrossRefGoogle Scholar
  46. Melone CP (1986) Open treatment for displaced articular fractures of the distal radius. Clin Orthop 202:101–111Google Scholar
  47. Memarsadeghi M, Breitenseher MJ, Schaefer-Prokop C, Weber M, Aldrian S, Gäbler C, Prokop M (2006) Occult scaphoid fractures: comparison of multidetector CT and MR imaging–initial experience. Radiology 240(1):169–176PubMedCrossRefGoogle Scholar
  48. Moneim MS, Bolger JT, Omer GE (1985) Radiocarpal dislocation–classification and rationale for management. Clin Orthop Relat Res 192:199–209PubMedGoogle Scholar
  49. Nakamura R, Horii E, Imaeda T, Tsunoda K, Nakao E (1995) Distal radioulnar joint subluxation and dislocation diagnosed by standard roentgenography. Skeletal Radiol 24(2):91–94PubMedCrossRefGoogle Scholar
  50. Nakamura R, Horii E, Imaeda T, Nakao E (1996) Criteria for diagnosing distal radioulnar joint subluxation by computed tomography. Skeletal Radiol 25(7):649–653PubMedCrossRefGoogle Scholar
  51. Nicolaidis SC, Hildreth DH, Lichtman DM (2000) Acute injuries of the distal radioulnar joint. Hand Clin 16(3):449–459PubMedGoogle Scholar
  52. Oneson SR, Scales LM, Timins ME, Erickson SJ, Chamoy L (1996) MR imaging interpretation of the Palmer classification of triangular fibrocartilage complex lesions. Radiographics 16(1):97–106PubMedGoogle Scholar
  53. Palmer AK (1989) Triangular fibrocartilage complex lesions: a classification. J Hand Surg 14A:594–606Google Scholar
  54. Papadimitriou NG, Christophorides J, Beslikas TA, Doulianaki EG, Papadimitriou AG (2005) Post-traumatic cystic lesion following fracture of the radius. Skeletal Radiol 34(7):411–414PubMedCrossRefGoogle Scholar
  55. Phillips CD, Keats TE (1986) The development of post-traumatic cyst-like lesions in bone. Skeletal Radiol 15:631–634PubMedCrossRefGoogle Scholar
  56. Raby N (2001) Magnetic resonance imaging of suspected scaphoid fractures using a low field dedicated extremity MR system. Clin Radiol 56(4):316–320PubMedCrossRefGoogle Scholar
  57. Raby N, Berman L, de Lacey G (2005) Accident and emergency radiology a survival guide, 2nd edn. Elsevier, AmsterdamGoogle Scholar
  58. Roach RT, Cassar-Pullicino V, Summers BN (2002) Paediatric post-traumatic cortical defects of the distal radius. Pediatr Radiol 32(5):333–339PubMedCrossRefGoogle Scholar
  59. Rodgers LF (2001) Radiology of skeletal trauma, 3rd edn, Chap. 17. Churchill Livingstone, LondonGoogle Scholar
  60. Shih C, Chang CY, Penn IW, Tiu CM, Chang T, Wu JJ (1995) Chronically stressed wrists in adolescent gymnasts: MR imaging appearance. Radiology 195:855–859PubMedGoogle Scholar
  61. Singh AK, Davis TR, Dawson JS, Oni JA, Downing ND (2004) Gadolinium enhanced MR assessment of proximal fragment vascularity in nonunions after scaphoid fracture: does it predict the outcome of reconstructive surgery? J Hand Surg Br 29(5):444–448PubMedCrossRefGoogle Scholar
  62. Sinha AK, Kaeding CC, Wadley GM (1999) Upper extremity stress fractures in athletes: clinical features of 44 cases. Clin J Sport Med 9(4):199–202PubMedCrossRefGoogle Scholar
  63. Smith ML, Bain GI, Chabrel N, Turner P, Carter C, Field J (2009) Using computed tomography to assist with diagnosis of avascular necrosis complicating chronic scaphoid nonunion. J Hand Surg Am 34(6):1037–1043PubMedCrossRefGoogle Scholar
  64. Thornton A, Gyll C (1999) Children’s fractures. WB Saunders, LondonGoogle Scholar
  65. Tiel-Van Buul MM, Van Beek EJ, Van Dongen A, Van Royen EA (1992a) The reliability of the 3 phase bone scan in suspected scaphoid fracture: an inter- and intra-observer variability analysis. Eur J Nucl Med 19:848–852PubMedCrossRefGoogle Scholar
  66. Tiel-Van Buul MMC, Van Beek EJR, Broekhuizen AH, Nooitgedacht EA, Davids PHP, Bakker AJ (1992b) Diagnosing scaphoid fractures: radiographs cannot be used as a gold standard. Injury 23(2):77–79PubMedCrossRefGoogle Scholar
  67. Tiel-Van Buul MN, Van Beek EJ, Born JJ, Gobler FN, Broekhuizen AH, Van Royen EA (1993) The value of radiographs and bone scintigraphy in suspected scaphoid fracture: a statistical analysis. J Hand Surg [Br] 18:403–406Google Scholar
  68. Tsai P, Paksima N (2009) The distal radio ulnar joint. Bull NYU Hosp Jt Dis 67(1):90–96PubMedGoogle Scholar
  69. Waizenegger M, Wastie ML, Barton NJ, Davis TRC (1994) Scintigraphy in the evaluation of the “clinical” scaphoid fracture. J Hand Surg [Br] 19B(6):750–753Google Scholar
  70. Webb BG, Rettig LA (2008) Gymnastic wrist injuries. Curr Sports Med Rep 7(5):289–295PubMedGoogle Scholar
  71. Yeager BA, Dalinka MK (1985) Radiology of trauma to the wrist: dislocations, fracture dislocations, and instability patterns. Skeletal Radiol 13(2):120–130PubMedCrossRefGoogle Scholar
  72. You JS, Chung SP, Chung HS, Park IC, Lee HS, Kim SH (2007) The usefulness of CT for patients with carpal bone fractures in the emergency department. Emerg Med J 24(4):248–250PubMedCrossRefGoogle Scholar
  73. Zanetti M, Saupe N, Nagy L (2007) Role of MR imaging in chronic wrist pain. Eur Radiol 17:927–938PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Department of RadiologyWesten InfirmaryGlasgowUK

Personalised recommendations