Wrist x-ray

[frazzledbutcalm]

Adult dd has been to minor injuries after hurting her wrist. It’s bruised, has a lump, is very painful, lower arm feels heavy. It’s the outer side, ulnar. They took X-rays from the basic angles - hand with palm flat to the board, then ulnar on the board so thumb side facing the top (hope that makes sense). Is it even possible to see the ulnar bones extensively from these angles?

Yes

Can I ask how? If the possible broken/chipped bone is at the underside of all the others, how would it be seen? We’ve had MANY missed fractures as a family.

Because clinicians are trained to assess the X-rays from standard angles. Non standard images are much much harder to interpret as you don’t have the years of experience of seeing them. Every unit I have worked in has a system for picking up missed fractures as sounds like you have been caught by this safety net previously.

I’d like that to be the case, but sadly not. First 2 fractures we were never recalled, took ourselves back after 9 days to be told bother fractures were clearly visible on initial X-rays. Another time a fracture was missed for 3 months despite 3 different X-rays - I pushed and pushed for ct/mri - eventually agreed, cue fracture being discovered - recovery took 18 months following that. Another was missed completely, healed itself in time, but was picked up on a separate random image funnily enough 🤨 There’s more, but that’s enough for now 😆

I don’t have faith unfortunately, and atm dd’s wrist is very sore, swollen, bruised, her arm feels heavy. There’s no way it’s a sprained ligament as they’ve suggested, as her wrist was hit directly by a heavy metal object - I assume a sprain is a twisting of some kind, not a direct trauma hit.

You can see bone through bone. Two views are really important to develop a 3D idea of what’s going on and, on both views, you’re looking at more than ‘just’ the bit that might be damaged - there’s the relationship of one bone to the others, unusual angulation, the joint spaces and soft tissues for example. All of that then needs interpreting with the context of the mechanism of injury and examination. Occasionally there won’t be anything very obvious but the clinical history might suggest a more serious injury (and serial imaging may help). Occasionally the imaging and history aren't that worrying and then reassurance with safety netting is sensible. Occasionally a second pair of eyes will spot something the first person missed and that’s why most images are reviewed at some point. X-rays need interpreting with the whole context , just like blood tests do and ECGs and all sorts of other tests. Medicine just isn’t that black and white a lot of the time.

Thank you @Greybeardy
It just doesn’t make sense. I can’t see how a heavy metal object hitting the wrist, can cause a ligament sprain. I guess we just wait and see.

It’s very unfortunate you’ve had so much bad luck with fracture identification. I have a broken thumb and had three X-rays on it last week and two breaks were detected. But as @Greybeardy says, it’s the 3D picture that is being built up.

If she’s unhappy she can seek a second opinion, presumably she went to minor injuries - so she can return and ask for her X-rays to be reviewed. That’s completely fine. Even when you have a break they state you can go back if it doesn’t clear up in the usual timeframe - if I still can’t bend my thumb in a fortnight then I have to go back.

Don’t get sprains and twists mixed up though. A sprain is a ligature injury and very painful. Twists can cause sprains but they aren’t sprains, if that makes sense?

Thank you @Arlanymor ,, they’ve said it’s a ligament sprain, but I don’t understand how that can be caused by the mechanism of injury. We’ll just see how it goes I guess.

Well I think that’s one of the mysteries of the human body to be fair. Some people have incredible accidents and walk away completely unscathed - others do something fairly innocuous and need bone grafts! I once broke my arm hugging someone if you can believe it! (I do give a damn good cwtsch though! And don’t worry - the other person survived too!) I really hope she feels better soon. I left my thumb for a week as I kept telling myself it was a bruise, much better now it’s in a mallet splint and I’m not knocking it every five minutes.

Yes very wise words I guess. She’s survived a burst, infected, abscessed appendix, liver failure due to ocp, other minor things along the way .. she’s pretty sturdy tbf 😵‍💫😂

She’s bomb proof by the sounds of it! Really hope she is on the mend soon.