Reading Wrist X-rays
A repeatable system for the AP and lateral.
Aug 15, 2026 · 3 refs
At a glance
Wrist films are only useful if you read them the same way every time. A system catches the second injury — ulnar styloid, DRUJ, carpal alignment — that a tired eye skips when it locks onto an obvious distal radius fracture.
Technique pointers
AP
- Radial height, radial inclination
- Ulnar variance
- Radiocarpal and midcarpal joint spaces
- Ulnar styloid / DRUJ relationships
Lateral
- Volar tilt of the distal radius
- Teacup / carpal alignment (capitolate axis)
- Soft-tissue swelling clues
Always ask: is this film adequate, and is there a second injury?
Decision-making
Use the system before you declare “simple distal radius.” Missed carpal injuries and DRUJ instability change the plan. If parameters look unacceptable after reduction, say so clearly — that is the decision, not a vague “looks okay.”
High-yield / exam
- Same order every time
- Measure or estimate key distal radius parameters
- Look for carpal alignment disruption
- Inadequate films → repeat, don’t guess
Questions
On call and Boards items for this topic are coming.
Open the bank →Your pearl
One line you’d tell a junior at 2am.
References
- 01
Essential radiographic evaluation for distal radius fractures
Medoff RJ · 2005 · Journal of Hand Surgery (American) · review
Defines practical radiographic parameters used in distal radius decision-making.
- 02
Radiographic evaluation of the wrist
2012 · Journal of the American Academy of Orthopaedic Surgeons · review
Systematic radiographic approach to wrist injury.
- 03
AAOS guidance related to distal radius fracture imaging and treatment decisions
2009 · American Academy of Orthopaedic Surgeons (guidelines / AUC) · guideline
Imaging quality and parameters inform operative thresholds.
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