Wrist Joint Radiographic Examination Technique in Patient with Fracture

X-Ray Department of Langkaplancar Hospital

Anggelia Gita Tiyananda
Radiodiagnostic and Radioteraphy Department of Semarang Health Polytechnics

ABSTRACT
Posterioranterior projection and lateral should be performed in radiographic examination of
wrist joint in fracture cases, But different techniques were performed in Radiology
Department of Langkaplancar Hospital.
This case report aims to know the knee joint radiographic examination technique of patient
with fracture in in Radiology Department of Langkaplancar Hospital.
Data were collected by observation an in depth interview to the radiographer,
patient,radiologist,and requesting physician on January 2017.
Wrist Joint Radiographic Examination in patient with fracture in Langkaplancar Hospital was
performed using PA oblique projection in supine position. Posterior anterior and lateral
projection was not performed due to uncoopeerative patient condition.
Wrist and posterior anterior projection should be done to get accurate diagnosis. Intensive
communication can increase patients motivation to fight the pain, so the optimum positioning
can be performed. Wrist Joint Radiographic Examinition in patien with fracture in
Langkaplancar Hospital was diferent to the theory.

INTRODUCTION
Positioning technique is a factor that greatly affect the diagnosis accuracy of radiographic
image, including in fracture case. PA projection should be performed the carpals,distal radius
ulna,and proximal metacarpals.Lateral projection should be performed anterior or posterios
displacement in the fractures (Merrill’s).

Practically, these technique are not performed in every radiology departments, including
Langkaplancar hospital. Wrist joint radiographic examination in fracture patient performed
using PA oblique projection in supine position and only on the affected side.

The aim of this case report is to describe the wirst joint radiographic examination procedure
in patient with fracture in Radiology Departement of Langkaplancar Hospital.

CASE PRESENTATION

Based on document study, Mr.Gonda felt pain on his right wrist since Maret 2017 that got
worse in patient used a plaster cast so that the patient's wrist could not be moved . He was
diagnosed He was diagnosed suffering fracture on his right wrist joint. Radiographic
examination was performed to support that diagnosis.

There were no special patient preparations. The equipments used are general purpose X-ray
unit, 18 x 24 cm X-ray Cassettes and Films, X-ray marker.

The performed projection was PA oblique in supine position. Patient’s wrist were positioned
in fully extended position.From pronated position, rotate wrist and hand laterally 45°. For
stability, place a 45° support under thumb side of hand to support hand and wrist in a 45°
oblique position or partially flex fingers to arch hand so that fingertips rest lightly on IR .The
X-ray cassette was placed lengthwise below the affected wrist, with only half area used. The
beam was centered on midcarpal area and perpendicular to the cassette. The Source to Image
Distance (SID) was 100 cm. Exposure factors was 43 kVp and 4 mAs.

PA oblique image are shown in figure below

The projection of the PA and Lateral was not performed because the patient's condition was
seriously ill and the patient used a plaster cast so that the patient's wrist could not be moved.

DISCUSSION

Bontrager (2014) fat stripe is visualized on the lateral view of the wrist.This pronator fat
stripe is normally visualized approximately 1 cm from the anterior surface of the radius.
Subtle fractures of the distal radius can be indicated by displacement or obliteration of the
plane of this fat stripe.

PA oblique projection should be performed using Posterior anterior. It can visualize the wrist
joint space between radius and ulna, so the not overlap of the distal radius and ulna. Patient
incomfortability can be reduce by intensive communication and motivation. Patient should be
motivated to fight the pain to reach accurate examination result.

CONCLUSSION

Wrist Joint Radiographic Examination in patient with fracture in Langkaplancar Hospital was
performed using PA oblique projection in supine position and . Anteriorposterior and lateral
projection was not performed because patient condition. PA oblique projection should be
done to get accurate diagnosis. Intensive communication can increase patients motivation to
fight the pain, so the optimum positioning can be performed.

REFFERENCE

Ballinger, P. W. 2011. Merril’s Atlas of Radiographic Positons and Radiologic Procedures ,

Volume Two, Twelfth Edition. St. Louis: CV. Mosby Company.
Bontrager, K. L. 2014. Textbook of Positoning and Related Anatomy, Eighth Edition. St. Louis:
CV. Mosby Company.