Understanding Wrist X-Ray

Despite significant advances in cross-sectional imaging, the plain radiograph remains the cornerstone and first-line investigation for evaluation of wrist pathology. Owing to the complex anatomy of the wrist, with eight closely packed carpal bones, interpretation of wrist radiographs can be challenging but is an essential skill for orthopaedic surgeons and trainees. A systematic understanding of wrist anatomy, biomechanics, standardized positioning, and radiological parameters allows accurate diagnosis of a wide spectrum of traumatic and non-traumatic conditions while minimizing the need for expensive advanced imaging. This article provides a practical, step-by-step approach to reading wrist X-rays, emphasizing correct positioning, interpretation of standard posteroanterior and lateral views, and assessment of key parameters such as radial inclination, radial height, ulnar variance, carpal alignment, Gilula’s arcs, and scapholunate relationships. The clinical relevance of lateral view parameters, including volar tilt, teardrop angle, scapholunate angle, and wrist column alignment, is discussed. Common pitfalls, normal variants, and radiographic signs of instability and dislocation are highlighted. In addition, the role and indications of special views for suspected scaphoid fractures and specific carpal bone injuries are reviewed. Mastery of these principles enables clinicians to extract maximum diagnostic information from minimal radiographs, ensuring timely and cost-effective patient care.

Keywords: Wrist radiograph, Carpal anatomy, Gilula’s arcs, Scaphoid fracture, Wrist instability, Special wrist views

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