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Plain Films - Forearm, Elbow and Hand

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Elbows

  • Supracondylar Fractures are common in children and initial trauma views should be taken with as little movement of the limb as possible.
  • Initial views should include whole forearm (both joints) in orthogonal views, as injury to both ends of radius and ulna should be excluded - even if patient has no pain in these areas.
  • DO NOT move an obviously deformed limb to get a perfect position.
  • Comparison views are sometimes requested but these should not be done unless requested by a radiologist or (after hrs) when requesting Dr has seen initial exam of affected side. (See NRL code of practice P 11 4.5)
  • It is important to get a good lateral (condyles superimposed) and a good AP: by this we mean that you can see the position of the capitellum clearly.
  • Follow up films in POP:  Plaster is often just a backslab, check this out and adjust exposure accordingly.

Radial Head

  • Elbow in lat position, forearm pronated.
  • Angle tube 45 deg up humerus, toward shoulder.T his gives an elongated view of radial head. Much easier for patients unable to move because of pain

Forearm

  • If possible position arm with elbow and wrist in lateral position. 
  • Then extend arm for AP elbow and wrist.
  • If child unwilling to move arm, do lateral elbow with wrist pronated.
  • Then, without moving arm, do horizontal ray lateral forearm and separate coned horiz ray AP elbow.
  • If there is obvious deformity /fracture DO NOT move affected limb.
  • Work around the injury in the position that it presents.
  • Two views at right angles including the # site will do. Both joints on one view will be sufficient in this case.  
  • It is often easier to do a separate horizontal ray   AP forearm and then AP elbow.

Wrist

  • Views for follow up of distal 1/3 radius/ulna # only
  • # any further up the radius /ulna needs whole forearm follow up.
  • Never do wrist only for initial views of injury.

Scaphoid

  • only when specifically requested
  • PA with ulnar deviation
  • PA oblique
  • PA with 20 deg angulation toward forearm
  • Lateral wrist

Hand

Trauma

  • DP, OBLIQUE and Lateral
  • Bandages MUST be removed - unless pressure bandage d/w CED first
  • LAT HAND: if doing lat hand (for all trauma hands and FB) please ensure that the hand is in line with the wrist which is also lateral. Fingers should be separated. Thumb out for arthritis.

Rheumatoid Arthritis

  • Bilateral DP , ball catcher and Lateral views. Include wrists.

Fingers

  • Trauma to fingertip- ALL bandages MUST be removed (discuss with  CED first )
  • Use Perspex strip to immobilise fingers if needed
  • DP, OBLIQUE and Lateral

RICKETS protocol

  • PA L  wrist
  • AP L knee

Bone age / renal osteodystrophy

  • Bone age films are L hand DP .
  • Position hand do that middle finger is in line with long axis of forearm.
  • Press wrist and fingers down flat

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Document Control

  • Date last published: 16 February 2017
  • Document type: Imaging Protocol
  • Services responsible: Paediatric Radiology

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