Upper Extremity Trauma: page 1 of 14 Wrist...Ulnar Variance Ulna shorter than Radius “Negative...

©Ken L Schreibman, PhD/MD 10/27/15 www.schreibman.info

page 1 of 14Upper Extremity Trauma:Wrist

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CollesTorusBartonScaphoid

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© 2015 Ken L Schreibman, PhD/MDwww.schreibman.info

Upper Extremity Trauma Wrist

Slide 1 of 84

3D Wrist CT

Frontalview

Ulna sideview

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Ulna sideview

Radius:

Frontalview

RadialStyloid

Arm:Radius rotates around ulna(radial head)

Lister’s Tubercle (dorsal)

Wrist: Radius is the foundation upon which the carpal bones reside

Looking down onarticular surface

LunateFossa

ScaphoidFossa

Anterior

Normal anterior (volar) (palmar) tilt of distal radius

Long axis of radius

Perpen-dicular to long axis

Normal2-20°volar

R R

[L] “ray”

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Slide 3 of 84

Scaphoid:

Frontalview

Ulna sideview

aka “Navicular of hand”(confusing Navicular in foot)

ScaphoidFossa

Waist

Distal pole sticks out anteriorly

ProximalPole

Scaphoid bridges the proximal and distal carpal rows

ProximalPole

DistalPoleDistal

Pole

R R

S S

[Gr]“boat”

Waist

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Slide 4 of 84

TFC

Lunate:

Frontalview

Ulna sideview

LunateFossa

R R

S S

L L

Should have opening upLike a teacup holding tea

Lunate sits ½ over radius (lunate fossa),½ over Triangular Fibro Cartilage (TFC)Lunate is nearly surrounded by cartilage

Lunate susceptible to AVN (Kienböck)

Onesmall artery anterior

Onesmallarteryposterior

[L] “moon”

ScaphoidFossa

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Slide 5 of 84

TFC

Proximal Carpal Row: (S+L+Tq+P)

Frontalview

Ulna sideviewR R

S

L L

PTq

PTq

Triquetrum (Tq): [L] “three-cornered”Pisiform (P): [L] “pea”

Radio-CarpalJoint

SL JtLT Jt

PT Jt

Pisiformstick outanterior

DistalPole

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Ulna major component of elbow, forearmRole at wrist is limitedDoesn’t even normally touch carpal bones

½ Radius fxs have Ulnar styloid fxs**Often remain

ununitedSeldom require

surgery(If DRUJ stable)TFC

Ulna:

Frontalview

Ulna sideviewR UU

S

L L

PTq

PTq

UlnaStyloid

[L] “arm”… related to “ell”, “cubit” *Unit of length equal to the forearm

*www.etymonline.com

DRUJ

Forms theDistalRadio-UlnarJoint

UlnaStyloid

**orthopedics.about.com

[L] “elbow”

http://www.schreibman.info/






http://www.etymonline.com/index.php?search=ulna

http://orthopedics.about.com/od/handwristfractures/f/styloidtreatment.htm



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Slide 7 of 84

TFC

Frontalview R U

S

L

PTq

PTq

C

UUlna side

view

L

C

Capitate: Head-shaped round proximal endsits inside open end of the lunate

R

CapitateLunateRadiusform a straight stack

[L] “head”AnatomyRadiographs

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Slide 8 of 84

TFC

Hamate:

Frontalview

Ulna sideviewR UU

S

L L

PTq

PTq

HC

Hook-shaped process (H)sticks out anterior

Pisiform

DistalPole

Hook of Hamatesticks outanteriorH

[L] “hook”

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Slide 9 of 84

TFC

Metacarpals

Frontalview

Ulna sideviewR UU

S

L L

PTq

PTq

HHC

Capitate articulates with Long finger MCHamate articulates with Ring & Small finger

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Slide 10 of 84

TFC

aka “Lesser Multangular”

Frontalview

Trapezoid:

Ulna sideviewR UU

S

L L

PTq

PTq

HHC

2 parallel sides

Trapezoid articulates with index finger MC

Td

[Gr] “table shaped”

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Slide 11 of 84

aka “Greater Multangular”

TFC

Trapezium:

Frontalview

Ulna sideviewR UU

S

L L

PTq

PTq

C HHTm Tm

no parallelsides

TrapeziUMarticulates

with the ThUMb

Td

[Gr] “little table”AnatomyRadiographs

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Slide 12 of 84

Carpal Tunnel

S PHTm

Walls of the carpal tunnel are made of the carpal bones that stick out anteriorly









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Slide 13 of 84

Hand ≠ Wrist

R,A 27yoM, fell off bike

HandPA

HandLat

HandObl

All Negative

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Slide 14 of 84

Hand ≠ Wrist

R,A 27yoM, fell off bike

Hand ≠ WristWristPA

WristObl

WristLat

WristUl Dev

Bennett Fracture!

Still Negative…

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Hand ≠ Wrist

G,M 44yoM

PA Hand

?

PA Wrist (next day)

!

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Hand vs Wrist: X-ray BeamHand radiographs:X-ray beam centered

@ 3rd MC head

G,M 44yoM

Wrist radiographs:X-ray beam

centered @ capitate

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Wrist: PA = Standard View

Marty age 15

Elbow @ shoulder height

Elbow @ 90°

Lowchair

Raise cassette

ShieldX-rays

X-ray beamPosteriorAnterior

= “PA”

X-ray beam centered on Capitate

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Slide 18 of 84

PA: Standard view

Wrist: PA ViewCarpal AlignmentProximal Carpal Row

Joint AlignmentRadio-Carpal JointCarpal-Metacarpal JtDistal Radio-Ulnar Jt

Ulnar LengthNormally, Ulna same

length as Radius

DRUJ

Ulna shorter

than Radius

R-C Jt

C-MC

D,H 21yoF









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Slide 19 of 84

Ulnar VarianceUlna shorter than Radius“Negative Ulnar Variance”Risk AVN Lunate (Kienböck)

Ulna longer than Radius“Positive Ulnar Variance”Ulna can punch hole in TFCUlna can impact upon Lunate

“Ulna Abutment Syndrome”

S,Z 18yoM

Ulna is only slightly shorter

than Radius

AVN Lunate with collapse

Radius shorteningT,C 14yoM

2 y earlier, normal unfused growth plates

Premature fusion radius,

continued ulna growth UV

Compared to normal side

Treated with ulna

shortening osteotomy

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Slide 20 of 84

Wrist: Lateral View

R

L

C,S 48yoM

CC

RAnterior

L

Normal2-20°volar

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Slide 21 of 84

Can see most carpal bones on Lateral

C,S 48yoM

C

R

L

SS

R

L

C

P

Hard to see Ulna as it overlaps Radius on a

good lateral view

U

PTq

Can’t see Triquetrum on lateral view…

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Slide 22 of 84

Triquetral FractureClassically presents

as a tiny avulsion fracture dorsal to the mid-carpus

There are no normal ossicles dorsal to the carpal bonesIf you see a small bone

back there, it’s a fractureMay be old, as these tiny

fractures don’t always healM,G 50yoM

Fx

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Slide 23 of 84

Wrist: Standard 3 ViewsPA View Lateral View

ThumbDown Thumb

Up

Oblique View

ThumbHalfway

Between

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Slide 24 of 84

Wrist: Oblique ViewBest view of:STT jointThumb C-MC jointCommon sites for OA

Additional view of:Carpals (scaphoid)MetacarpalsRadius (styloid)Sometimes a fracture is

seen only on this view

K,M 20yoF

S

Tm TdMC









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Slide 25 of 84

Scaphoid (Ulnar Deviation) View

S,B 21yoF

Patient holds wrist in ulnar deviation

Yields an elongated view of the scaphoid.

Helps when looking for fractures.

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Slide 26 of 84

4 View Series for Scaphoid Fracture

K,T 32yoF

Lateral View

PA View Oblique View Scaphoid View

Doesn’t show scaphoid well

Dorsalswelling

Negative Negative? Positive!scaphoid waist fx

?

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Slide 27 of 84

Wrist: CTGood for complex fracturesAid in surgical planningGood to assess fracture healingEven in the presence of metal

E,A 18yoM

PA view Scaphoid view

CT:Coronal Acutrak®

screwCT:Obl Sag

Fx?

Fx

Fx! S LTq

HCTd

CT:Obl Sag

R

Fx! S

R

Tm

Healed!

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Wrist CT: Positioning

We don’t scan patients with their wrist down at their sideExcess radiation across torsoX-ray scatter decreases res.

We scan patients with their wrist over the head

No excess radiation to bodyNo x-ray scatter

Mighty MousePosition

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Slide 29 of 84

Wrist: CTNOT good for occult fracturesFractures non-displaced on radiographs…

…are non-displaced on CT

L,N 21yoF

PA viewScaphoid view

No fracture

CT: Coronal MR: T1 Coronal

Blackfractureline

MR: T2fs Coronal Acutrak® screw

No fracture

Marrow edema

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Slide 30 of 84

Wrist MR: Positioning

Wrist coil

We scan patients with their wrist over the head

In a wrist coil Functions best in the center of

the magnetic field









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Fall On Out-Stretched Hand (FOOSH)Most injuries to the wrist are due to one

common mechanismPerhaps THE most common injury

1-in-6 ER fractures occur in the distal radius*Humans are a clumsy speciesWe walk uprightWe’re top heavyWhen falling, we instinctively protect our head, byExtending our armStriking the ground with our hand

This mechanism of injury is perhaps UNIQUE to humans

*orthopedics.about.com

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Slide 32 of 84

The most famous penguin on the Internet

www.youtube.comwww.youtube.com

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Slide 33 of 84Marty age 8½

HANDS

ULNA

RADIUS

Fall On Out-Stretched Hand (FOOSH)

FOOSH

HyperextendWrist

HyperextendWrist

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Slide 34 of 84

Fall On Out-Stretched Hand (FOOSH)Hyperextension of wrist Hyperextensive forces on:RadiusColles fractureTorus fracture (children)

Carpal bonesBarton fractureScaphoid fractureLunate/perilunate dislocations

S

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Slide 35 of 84

Transverse Fx distal radiusHyperextension forces cause:Dorsal angulation± Dorsal displacement

Colles Fracture

S

Fx

R,C 92yoF O,M 20yoM

DORSAL ANGULATIONALWAYS ABNORMAL!

Lateral view Lateral view

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Slide 36 of 84

Dorsal Angulation is BadTo measure angle:Draw line along

distal radiusFrom front cornerTo back corner

Draw line along shaft of radiusPerpendicular to this

Measure this angleNormal is VOLAR2-20°

Dorsal = Abnormal

R,C 92yoF

Lateral view

5°Dorsal

20°Dorsal

2 weeks later…

The ligaments are not designed to support carpal

bones on a dorsal sloped radius

Lateral view


http://orthopedics.about.com/od/handwristfractures/f/styloidtreatment.htm


http://www.youtube.com/watch?v=UtLiQFtKVj8&NR=1

http://www.youtube.com/watch?v=kGy_7gY4f1o







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Slide 37 of 84

Must reduce angle to heal right

M,D 59yoF

ER lateral view:Marked dorsal angulation

Following reduction & casting in ER:

Volar angulation

6 weeks later:Healing, normal

volar angulation

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Slide 38 of 84

Colles fractures very commonIn childrenFall a lotTorus fracture

In womenOsteopenia2 women in

my life…

In the media…

Secretary Judy Wife Lynn

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Slide 39 of 84

Colles vs Smith Fracture

Anatomically impossible?

Season 15, Episode 2original air date 9/22/04

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Slide 40 of 84

S

Colles:Hyper-

extensionDORSAL

angulation

Smith:Hyper-

flexionVOLAR

angulation

Smith Fracture = Reverse Colles

S,K 51yoF

Lateral view:Too much volar angulation

Reduction & cast:Normal volar angulation

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Slide 41 of 84

FOOSHColles:Hyper-

extensionDORSAL

angulation

Mechanisms: Colles vs SmithAnatomyRadiographs

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Slide 42 of 84

Mechanisms: Colles vs Smith

FOOSH Hyperextension Colleswhether fall Forwards or Backwards




http://www.imdb.com/title/tt0629232/






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Slide 43 of 84

Mechanisms: Colles vs SmithFall onto Back of handHyper-

flexionSmith FxVOLAR

angulation

Colles:Hyper-

extensionDORSAL

angulation

Smith fracture

is much less

common than

Colles

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Slide 44 of 84

Abraham Colles (1773-1843)

“The injury to which I wish to direct the attention ofsurgeons, had not, as far as I know, been described byany author.”

“I should consider this as by far the most commoninjury to which the wrist or carpal extremities of theradius and ulnar are exposed.”

babel.hathitrust.org

(81 years before

Roentgen)

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Slide 45 of 84

Robert William Smith (1807-1873)

google.combooks.google.com

(1847?) MDCCCL=1850

Page 162



http://babel.hathitrust.org/cgi/pt?u=1&num=182&seq=1&view=image&size=100&id=mdp.39015020923374


http://www.worldortho.com/dev/index.php?option=com_content&view=article&catid=&id=149:foundations-of-modern-orthopaedics

http://books.google.com/books?id=DjgAAAAAQAAJ&printsec=frontcover&source=gbs_ge_summary_r&cad=0



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Slide 49 of 84

RADIUS

PowerPoint ModelAdult Lateral

Fractures in Children

A

RADIUS

PowerPoint ModelChild Lateral

Epiphysis

physis(growth plate)

Metaphysis

Diaphysis

K,V 2yoM

Lateral PA view AnatomyRadiographs

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Slide 50 of 84

FOOSH Fractures in ChildrenAdult bones: BrittleSnap under forceChild bones: SoftBend under forceFOOSH Hyperextension distal

radial metaphysisBuckling metaphysis-

diaphysis junctionBuckle Fracture“Torus Fracture”

RADIUS

PowerPoint ModelChild Lateral

RADIUS

A

G,A 5yoM

Lateral

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Slide 51 of 84

Torus Fractures: Lateral ViewCortex buckles INFOOSH (Colles)Dorsal cortex

Fall on back of wrist (Smith)Volar cortex

Nature does not make angles…Nature makes smooth curvesIf you see cortex angulation ina child that should be smooth,

it’s likely a torus fracture!

RADIUS

S,A 5yoF

Lateral

Cortex of radius & ulna overlap

A,C 6yoM

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Slide 52 of 84

Torus Fractures: PA View

FOOSH

AxialLoad

RADIUS

AxialLoad

RADIUS

AxialLoad

Cortex bucklesOUTWARD

PowerPoint ModelChild PA View

PA view

H,T 8yoF

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Slide 53 of 84

Torus Fractures: Common…Run eyes along cortexFocus on

metaphysisPA viewBuckles

outwardNot sure?Compare to

normal sideUse other

views!

Subtle

A,B 14yoF

PA viewSymptomatic side

PA viewAsymptomatic side

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Slide 54 of 84

Torus Fractures: Common…Run eyes along cortexFocus on

metaphysisLat viewBuckles

inwardNot sure?Compare to

normal sideUse other

views!

SubtlePA viewSymptomatic side

Lat viewAsympt.

Lat viewSympt.

A,B 14yoF









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Slide 55 of 84

“Torus”Capital

S

h

a

f

t

BasePlinth

Torus

RadioGraphics 2004; 24:p1025

[L]:“swelling,protuberance,bulge”[Architecture]:A large convex molding, semicircular in cross section, at base of a classical column.

Wisconsin State Capitol

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Slide 56 of 84

Fall On Out-Stretched Hand (FOOSH)Hyperextension of wrist Hyperextensive forces on:RadiusColles fractureTorus fracture (children)

Carpal bones(Proximal carpal row)Barton fracture

S

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Slide 57 of 84

Barton FractureHyperextension of wrist Impaction of carpal bones on radius dorsal rim Fracture radius rimIntra-articular fracturePotentially more serious than Colles

(extra-articular fracture)May require surgical fixationSurgeon may order CT for planning

S

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Slide 58 of 84

Dorsal Barton FractureDorsal BartonDue to FOOSHis much more common than

Volar BartonDue to blow to

back of wrist

(Just as Colles is much more common than Smith fracture)

S

S,G 37yoM

Lateral view

M,M 58yoF

Lateral view

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Slide 59 of 84

Volar Barton Fracture

S

Lateral view

A,D 43yoM

CT: Sagittal OpenReductionInternalFixation

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Slide 60 of 84

John Rhea Barton (1794-1871)

www.kmle.co.krThe Medical ExaminerNov 7, 1838; 1, 23; p 365-8

It was said that Barton was ambidextrous and that once he had positioned himself for an operation, he did not move about.

whonamedit.com


http://radiographics.rsna.org/content/24/4/1009.full.pdf






http://www.kmle.co.kr/search.php?Search=Barton, John Rhea

http://search.proquest.com.ezproxy.library.wisc.edu/docview/136837731/1341E9D945F5C7B6F36/4?accountid=465

http://www.whonamedit.com/doctor.cfm/2416.html



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Slide 61 of 84

Fall On Out-Stretched Hand (FOOSH)Hyperextension of wrist Hyperextensive forces on:RadiusColles fractureTorus fracture (children)Carpal bones

(Proximal carpal row)Barton fracture(Distal carpal row)Scaphoid fracture

S

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Slide 62 of 84

Scaphoid FracturesScaphoid THE most common

carpal bone to be fractured.

71% of all carpal fxs*Scaphoid bridges

the carpal rowsTraumatic shear forces

between the rows …shearing fracture across the scaphoid

*emedicine.com

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Slide 63 of 84

Scaphoid Fractures Locations

S,A 24yoM

PA View Wrist

Scaphoid Waist70% of scaphoid fractures

occur at the waist

www.gentili.netB,J 21yoM

Scaphoid Proximal Pole20% occur at scaphoid proximal poleIncreased risk of non-union/AVN

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Slide 64 of 84

Scaphoid Fractures LocationsPA View Wrist

Scaphoid Distal Pole10% occur at distal pole

These are usually uneventful*

PA View Wrist

Scaphoid TubercleRare, usually uncomplicated.If nonunion, usually asympt.*

*emedicine.comB,T 44yoMT,B 20yoM

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Slide 65 of 84

Scaphoid & Radius FracturesSame common mechanism (FOOSH)Distal Radius FractureScaphoid Fracture…BOTH!

Watch out for “satisfaction of search”“Aha, I found the fracture… I’d done looking”

Old Radiology Axiom:The hardest fracture to find is the 2nd fracture

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Slide 66 of 84

Scaphoid with Radius Fracture

W,M 19yoF

PA View Wrist Obl View Wrist PA View Wrist

Colles

UlnaStyloid

Proximal Pole

Plate fixates Colles

fracture

Screw fixates

scaphoid fracture



http://emedicine.medscape.com/article/397230-overview


http://www.gentili.net/fracture.asp?ID=104


http://emedicine.medscape.com/article/397230-overview





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Slide 67 of 84

22yo M03:00Unbelted passengerHigh speed MVCT-boned by minivanAir bags deployedTook 20 minutes to

extract from car

Intubated

Scaphoid doesn’t heal as well as other bones

V,G 22yoM

FB

…

Acetabularfracture

PA View Hand 2 months later…Healing

FB

OK

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Slide 68 of 84

Scaphoid doesn’t heal as well as other bonesafter 4 months…

FB

OK

CT: Coronal

OK

FBCT: SagittalOblique

Non-union scaphoid

waistV,G 22yoM

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Slide 69 of 84

Scaphoid has a tenuous blood supplyRadial artery

supplies:Distal Pole (DP)

of Scaphoid (S) Not Proximal Pole (PP)

The more proximalthe fracture, the

greater the risk of non-union.

The more distracted the fracture, the

greater the risk of non-union.

PAHandOblHand

S

DP

PP

RadialArtery

S

Heavy arterial calcificationPt w/ diabetes, renal failure

L,T 60yoM

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Slide 70 of 84

Scaphoid Non-Union AVN

Q,B 62yoF

PA View Wrist CT: Coronal CT: SagittalOblique

Non-union scaphoid waist fx

Collapse & fragmentation

PP = AVN

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Slide 71 of 84

Proximal Row CarpectomyLateral View WristPA View Wrist

Resection: Scaphoid, Lunate, TriquetrumRadius articulates with Capitate (distal row)Only treatment for fragmented scaphoid AVN

R

C

Q,B 62yoF

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Slide 72 of 84

To avoid non-unionAVNPRCAll scaphoid fxs require early treatment!Probably with a screw if displacedAt least with a splint or cast if non-displaced

But non-displaced fractures are hard to see because they are non-displaced

So how do we know if a patient has a non-displaced scaphoid fracture?

SNUFFBOX TENDERNESS =PRESUMED SCAPHOID FRACTURE









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Slide 73 of 84

Anatomical Snuffbox

Extensor Pollicis Longus Tendon

Extensor Pollicis Brevis Tendon

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Slide 74 of 84

Snuffbox Tenderness= PRESUMED SCAPHOID FRACTUREWhat if the radiographs are normal?Beautiful! Then it’s a non-displaced fractureTreat anyway with a cast/splintMake sure radiologist agrees they’re negative

Have patient follow-up in 2 weeksRe-examine… if still tender… back into the splintGet repeat radiographs (out of the cast/splint)We’re taught occult fxs become visible after 1-2 weeks

from bone resorption at fx margins… I’m not sure it’s true…

If you really need to know…MRI (we don’t miss fractures on MRI)

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Slide 75 of 84

Resorbtion of Fracture Margins?

M,D 55yoM, cutting tree branches, FOOSH 15ft

Scaphoid View Oblique View

No scaphoid fx No scaphoid fx No scaphoid fx…

Radius fracturesImportance of multiple views!

PA View AnatomyRadiographs

4 Views

CT/MRFOOSH


WOW



Slide 76 of 84



PA View8 days laterStill snuffbox tenderness

Still noscaphoid fx

MRI: 19 days after injuryCoronal T1 Coronal T2fs

Bone marrow edema in Radius

Blackfx line

Blackfx line

Bone marrow edema in Scaphoid

Blackfx line

Occult scaphoid fracture!

No resorbtion scaphoidfracture margins

AnatomyRadiographs

4 Views

CT/MRFOOSH


WOW



Slide 77 of 84



Scaphoid View Oblique ViewPA Viewafter 29 days…

Still see lucent radius fractures

Still no resorbtion scaphoidfracture margins

Negative radiographs do not exclude a scaphoid fractureSnuffbox Tenderness = Presumed Scaphoid Fracture!

AnatomyRadiographs

4 Views

CT/MRFOOSH


WOW



Slide 78 of 84

Anatomical Snuffbox?snuffhouse.org

www.snuffstore.co.uk schmalzlerfranzl.de







http://snuffhouse.org/discussion/1112/jaxons-english-toffee-mccrystals-mild-lemon

http://www.snuffstore.co.uk/news/2008/04/06/snuff-snow/

http://www.schmalzlerfranzl.de/module.php5?am=3&fid=7&ident=1&mod=vorlagen



AnatomyRadiographs

4 Views

CT/MRFOOSH


WOW



Slide 79 of 84

Wrist: What to Order When (WOW)Radiographs:

Trauma PainArthritis (Hand radiographs)

CTSurgical planning known fracturesMROccult fractures (scaphoid)Synovitis (w/Gd) (Usually includes MCPs ± IPs) …pain?

RG95% CT

2%

MR3%

UW data 2005 & 2014

AnatomyRadiographs

4 Views

CT/MRFOOSH


WOW



Slide 80 of 84

Wrist: What to Order When (WOW)Wrist Radiographs (95%)3-view wrist seriesPA (not AP)LateralOblique

If snuffbox tenderness, add 4th viewScaphoid (ulnar deviation)

If snuffbox tenderness+negative radiographsTREAT AS PRESUMED SCAPHOID FRACTURECast/splint, follow-up in 2 weeksIf still has snuffbox tenderness, keep treating

AnatomyRadiographs

4 Views

CT/MRFOOSH


WOW



Slide 81 of 84

Wrist: What to Order When (WOW)Wrist CTPredominantly used for surgical planning of

known radius/carpal bone fracturesOrdered by Orthopedics from ER or clinic

Assess healing of known scaphoid fractureWith or without prior screw fixationSmall screws cause virtually no CT artifacts

We always reformat in 3 orthogonal planesFor scaphoid, we add oblique sagittal

We have a specialized protocol for DRUJ instabilityAll protocols at: www.radiology.wisc.edu

AnatomyRadiographs

4 Views

CT/MRFOOSH


WOW



Slide 82 of 84

Wrist: What to Order When (WOW)Wrist MROccult fractures (scaphoid)Persistent symptoms despite negative radiographs

Synovitis (RA)Needs IV contrastNormal synovium does not enhanceVascularized pannus greatly enhances

Ordering provider should specify area of concernJust intercarpal jointsAlso Metacarpal-phalangeal jointsAlso Interphalangeal joints

Field of View = Resolution

AnatomyRadiographs

4 Views

CT/MRFOOSH


WOW



Slide 83 of 84

Wrist: What to Order When (WOW)Wrist ChargesWrist Radiographs 3 views = 4 views = $137It costs nothing to add the scaphoid view to a 3 view series

1 view = 2 views = $128Going from 2 views to 4 views adds only $9 (7%)

Wrist CT (without contrast) = $1,460

Wrist MR (without contrast) = $2,921 (with contrast) = $3,377

UWMF charges 2012

AnatomyRadiographs

4 Views

CT/MRFOOSH


WOW



Slide 84 of 84

That’s all we have on wrists…

Marty age 7




http://www.radiology.wisc.edu/

http://www.radiology.wisc.edu/




Upper Extremity Trauma: page 1 of 14 Wrist...Ulnar Variance Ulna shorter than Radius “Negative...

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Transcript of Upper Extremity Trauma: page 1 of 14 Wrist...Ulnar Variance Ulna shorter than Radius “Negative...