Laboratory Studies
No laboratory studies are indicated in cases of isolated wrist injury. However, erythrocyte sedimentation rate analysis can be helpful for monitoring the degree of inflammation involved with a chronic wrist problem.
Imaging Studies
The majority of wrist fractures can be assessed adequately with good-quality anteroposterior (AP) and lateral radiographic images. [12] The palmar slope of the articular surface of the distal radius is appreciated on a lateral x-ray film of the wrist. A slope of 11 º is normal.
For distal radius fractures, measure the palmar slope to assess the degree of angulation. Determine whether the fracture is intra-articular, and note the presence of any step-off at the articular surface. The ulnar styloid is chipped in approximately 60% of all patients with this fracture.
For scaphoid fractures, the fracture may be at the wrist, tuberosity, or proximal pole. If a scaphoid fracture is strongly suggested, a posteroanterior view of the scaphoid with the wrist in ulnar deviation may distract the fragments and make the fracture more apparent.
A bone scan or magnetic resonance imaging study may be necessary to detect occult fractures that may not be visualized on plain radiographs. [13, 14]
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Total volar displacement of distal radius fracture from patient fall; mechanism consistent with Smith fracture. Posteroanterior (PA) view of left wrist shows complex comminuted fracture deformity of the distal radius with overlap of the fracture fragments and antipalmar angulation of the fracture apex.
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Total volar displacement of distal radius fracture from patient fall; mechanism consistent with Smith fracture. Anteroposterior (AP) external rotation view of left wrist shows complex comminuted fracture deformity of the distal radius with overlap of the fracture fragments and antipalmar angulation of the fracture apex.
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Total volar displacement of distal radius fracture from patient fall; mechanism consistent with Smith fracture. Lateral view of left wrist shows ulnar sided subluxation of the ulna in relation to the distal carpal bones.
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Reduction obtained by volar inversion of hand on forearm and axial traction. Posteroanterior (PA) view of left wrist post-reduction shows interval reduction of the comminuted fracture of the distal radius with probably extension of fracture lines to the articular surface.
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Reduction obtained by volar inversion of hand on forearm and axial traction. Lateral view of left wrist post-reduction shows interval reduction of the ulnar subluxation.
