Imaging Case of the Week 581 Answer

The wrist x-rays show

multiple fractures but the main injury is trans scaphoid perilunate dislocation.

There are also fractures involving the radial styloid, ulnar styloid, triquetral bones.

The patient needs urgent referral to specialist for emergency management in theatre. Assess and document neurovascular status in the affected hand.

This x-ray is a good example to show satisfaction of search – do not be satisfied with identification of one injury. Keep looking to spot associated other injuries on x-ray.

Imaginary drawing of Gilula arc on frontal wrist x-ray allows for identification of multiple carpal bone fractures. Further information on Gilula arc and detailed assessment of wrist on imaging can be found –