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Duke Orthopaedics
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Wheeless' Textbook of Orthopaedics

Posterior Anterior View of the Wrist



- See:
       - AP view
       - Carpal height & Carpal height ratio 
       - Clenched Fist AP
       - Radial Inclination
       - Radial Length & Width
       - Ulnar Variance
       - X-ray for Distal Radius Frx

- Discussion:
    - AP View is prefered for Wrist Pathology:
    - palmar surfaces of most carpal bones are narrower, & these bones are best profiled in AP projection because of the alignment of the peri-articular cortices with the diverging incident x-ray beam;
    - position of ulnar styloid will help determine which way film was obtained;
            - in standard PA view, ulnar styloid is peripheral;
            - in standard AP view, ulnar styloid points centrally;
            - radius effectively shortens with pronation and lengthens with supination;
 
- Technique:
    - PA view is taken with the palm flat on the table, elbow abducted to shoulder height and flexed to 90 deg, w/ forearm and wrist in neutral rotation;
    - if palm is not flat on the film, CMP joints will be extended and will not be profiled correctly;

- Gilula's arcs:
    - on PA view, articular surfaces of carpal bones should be parallel joint spaces should have similar width & have parallel cortical margins;
    - broken arc, loss of parallelism, and widening or overlapping of normally parallel joint spaces are strongly suggestive of ligamentous, bone, or joint injury & necessitate further evaluation;

- Radial Ulnar Joints: (PA)
    - wrist pronation (PA view) causes positive variance whereas supination achieves the opposite result;
    - distal radioulnar joint should measure approximately 2 mm;
    - if there is a of a radio-ulnar joint disruption consider CT scan



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, August 13, 2012 4:45 pm