The Sensitivity of the Scapholunate Interval and Bony Landmarks to Wrist Rotation on Posteroanterior Radiographs.

Background: The objective of this study was to examine the effect of wrist rotation on the scapholunate interval in the posteroanterior radiograph and to identify radiographic landmarks on the posteroanterior projection that can be used to assess position.

Methods: Eleven healthy cadaveric wrists were radiographed in the neutral position and subsequently were rotated and imaged from 30° pronation to 30° supination in 10° intervals. At each interval, the scapholunate interval was measured as well as the following landmarks: (1) the visible perimeter of the base of the hook of the hamate; (2) the radial-ulnar distribution of the dorsal nonarticular surface of the distal third metacarpal head; (3) the radial-ulnar distribution of the pisiform about the longitudinal axis of the ulna; and (4) the overlap of the pisiform and triquetrum.

Results: The scapholunate interval was largest in the neutral position and linearly decreased by 34% for every 10° of pronation and decreased nonlinearly by 86% after the first 10° of supination. The appearance of the distal third metacarpal head was shown to be sensitive to both pronation and supination. The perimeter of the hook of the hamate and the distribution of the pisiform compared to the ulna were both shown to be sensitive to supination, whereas overlap of the pisiform and triquetrum was not shown to be sensitive to either direction of rotation.

Conclusions: Our results highlight the significant effect of rotation on radiographic landmarks at the wrist, indicating that 10° of supination can drastically alter the developed radiograph.