Radiography: antebrachium

• A high definition film-screen combination is required.
• A grid is not required.
• kV should not exceed about 50.
• Soft tissues should be included.
• General anesthesia or heavy sedation is required.
• The film should be correctly exposed and developed, and free from movement blur and artifact.
• The anatomical marker must be clearly visible, along with the patient's identification, the date, and the name of the hospital or practice.

• Fracture Fracture: overview   .
• Neoplasia (distal radius).
• Premature distal ulna growth plate closure (angular limb deformity).

Advantages

• Non-invasive.
• Straightforward.

Preparation

• Dependent upon the method of chemical restraint (GA or sedation).

Procedure

• 10 to 15 minutes, or longer, dependent upon skill of radiographer.

Criteria for choosing test

Is the examination appropriate?

• Can you make the diagnosis without it?
• Can it tell you what you need to know?
• Will your management be affected by the radiological findings?

Choosing the right projections

Lateral

• Standard projection.

Craniocaudal

• Standard projection.
• Two views always necessary.

Other involvement

• Radiographer, or Technician carrying out radiography.

Minimum equipment

• X-ray machine.
• Cassettes with high definition screens.
• Processing facilities.
• Immobilization and positioning aids: sandbags, foam wedges, tying tapes.
• Protective clothing (lead-rubber aprons).

Ideal equipment

• High output X-ray machine.
• Rare earth high definition screens.
• Automatic processing facilities.

Minimum consumables

• X-ray film.
• Pharmaceuticals for chemical restraint.

• One to two competent people.
• Sandbags.
• Foam wedges.
• Tying tapes.

Step 1 - Lateral

• Position the patient in lateral recumbency on the side to be examined and immobilize.
• Use padding under the shoulder and carpus as necessary to ensure that the radius and ulna are parallel to the film and in a lateral position .
• Check that both the elbow and the carpus are in the true lateral position.
• Secure the limb at the carpus.
• Center with a vertical beam at mid-shaft level.
• Collimate to include both the antebrachio-carpal joint and the elbow, and the skin surfaces on the cranial and caudal aspects .

Step 2 - Craniocaudal

• Place the patient in sternal recumbency.
• Extend the affected limb as far cranially as possible and secure .
  If the elbow and shoulder are not in full extension it will be very difficult to maintain an unrotated craniocaudal position of the radius and ulna.
• Place the thin end of a 15 degree foam wedge between the elbow and the film. This will facilitate achieving the true craniocaudal position.
• Rotate the limb until the point of the elbow is palpable beneath the middle of the cranial aspect ie until the elbow is in a true craniocaudal position.
  To prevent the elbow from slipping laterally, place padding at the lateral aspect, with a heavy sandbag lateral to that.
• Secure the limb at the carpus if necessary.
• Center mid-shaft.
• Collimate to include both joints (and as far as the metacarpals in the case of angular limb deformity) and the skin surfaces laterally and medially .

• Inadequate sedation.
• Poor technique: inaccurate positioning or centering, wrong exposure factors.
  The most common positioning problem is rotation in the craniocaudal position.
• Follow the tips to ensure that this does not happen.
• Poor processing.
• Equipment failure.

Refereed papers

• Recent references from PubMed and VetMedResource.